Improving uptake and adherence to HIV prevention services with PrEP, HIV self-testing and adherence support for very high risk HIV-negative young women aged 15-24 in Kampala, Uganda

项目总结 撒哈拉以南非洲(SSA)是世界上增长最快、最年轻的人口的家园，包括 全球艾滋病毒感染率最高的国家。SSA超过一半的人口年龄在25岁以下 年龄。10-24岁的男子和妇女，被联合国人口基金(人口基金)定义为“年轻人”， 占萨族人的三分之一，而且这一比例还在继续增长。SSA中的年轻女性 在经济和教育方面处于不利地位的人从事交易性行为的风险很高。性工作者 16岁以下的性工作新手比他们的年长同事更容易受到暴力、性传播感染和艾滋病毒的影响。AS 性工作在乌干达是非法的，这增加了这些年轻女性面临的风险。有效的性传播感染和艾滋病毒 预防、护理、支持和生殖健康服务至关重要。关于采取干预措施的证据 高危人群对艾滋病毒预防服务的接受和坚持有限，但干预措施 地址YWHR几乎是不存在的。为响应RFA-MH-17-560，我们建议使用R34来开发 对15至24岁未感染艾滋病毒的妇女进行全面干预，包括预防接种和艾滋病毒自我检测 在乌干达坎帕拉从事高危性行为，并进行试点试验以评估其可行性， 可接受性和对PrEP吸收和依从性以及重复HIV自我检测的潜在影响。我们会 将这项研究嵌入我们现有的队列研究(NIMH R01 HD085805-01，Pi King)，揭示了 年轻的性工作者在进入这个行业后不久就需要给予更多的关注，因为他们已经取得了初步的成果 在我们的动员努力中，艾滋病毒流行率比预期高得多。这项干预将 重点增加PrEP的启动，增强依从性支持，通过自我接受重复艾滋病毒检测 对性传播感染、艾滋病毒和计划外感染采取和维持性风险降低行为的测试和动机 怀孕了。具体目标是(1)进行形成性研究，以加深我们对 社会和性网络的动态，以及从事高危性行为的妇女(15-24岁)的背景 乌干达坎帕拉的行为以及PrEP吸收和遵守以及重复的障碍和机会 通过自我检测进行艾滋病毒检测；(2)开发和检测社会和文化上可接受和可行的预防措施 对艾滋病毒高危青年妇女接受和遵守PrEP和艾滋病毒自我检测的干预；(3) 将试点研究中学到的经验教训转化为更大规模的随机对照试验的设计。拟议中的项目反应迅速 总统艾滋病紧急救援计划和世界卫生组织的几个优先领域 关于在年轻人中预防艾滋病毒的问题。我们的提案代表了开发一种 综合生物-行为-结构方法在年轻女性中预防艾滋病毒 有限的设置。

PROJECT SUMMARY Sub-Saharan Africa (sSA) is home to the fastest growing and youngest population in the world and includes countries with the highest HIV prevalence globally. More than half of sSA's population is under 25 years of age. Men and women aged 10-24, defined as `young people' by the United Nations Population Fund (UNFPA), represent one third of the sSA population and this proportion continues to grow. Young women in sSA who are economically and educationally disadvantaged are at high risk of engaging in transactional sex. Sex workers under 16, new to sex work are much more vulnerable than their older colleagues to violence, STIs and HIV. As sex work is illegal in Uganda, this contributes to the risk these young women face. Effective STI and HIV prevention, care, support, and reproductive health services are critical. Evidence on interventions that address uptake and adherence to HIV prevention services for high-risk populations is limited, but interventions that address YWHR are almost non-existent. In response to RFA-MH-17-560, we are proposing a R34 to develop a comprehensive intervention including PrEP and HIV self-testing for HIV-uninfected women 15- to 24-years old who engage in high-risk sexual activity in Kampala, Uganda, and conduct a pilot trial to evaluate its feasibility, acceptability and potential effect on PrEP uptake and adherence as well as repeat HIV self-testing. We will embed this study within our existing cohort study (NIMH R01 HD085805-01, PI King) that has revealed the need for greater attention to young sex workers soon after their initiation into the profession given early results in our mobilization efforts that have shown much higher HIV prevalence than expected. The intervention will focus on increasing initiation of PrEP with enhanced adherence support, uptake of repeat HIV testing by self- test, and motivation to adopt and sustain sexual risk reduction behaviors for STI, HIV, and unplanned pregnancy. The specific aims are (1) To conduct formative research to enhance our understanding of the dynamics of the social and sexual networks, and context of women (aged 15-24) engaged in high risk sexual behavior in Kampala, Uganda and barriers and opportunities for PrEP uptake and adherence as well as repeat HIV testing by self test; (2) To develop and test a socially and culturally acceptable and feasible prevention intervention on uptake and adherence to PrEP and HIV self-testing for young women at high risk for HIV; (3) to translate lessons learned in the pilot study into the design of a larger RCT. The proposed project is responsive to several priority areas of the President's Emergency Plan for AIDS Relief and the World Health Organization regarding HIV prevention among young people. Our proposal represents one of the first studies to develop an integrated bio-behavioral-structural approach to HIV prevention among young women at high risk in resource- limited settings.