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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

乌干达坎帕拉 15-24 岁的高危艾滋病毒阴性年轻女性通过 PrEP、艾滋病毒自我检测和依从性支持提高艾滋病毒预防服务的接受度和依从性

基本信息

批准号：
9763656
负责人：
Rachel Lisa King
金额：
$ 18.01万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-08-25 至 2022-01-31
项目状态：
已结题

项目摘要

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.

项目概要撒哈拉以南非洲 (sSA) 是世界上人口增长最快、最年轻的地区，包括全球艾滋病毒感染率最高的国家。南澳州一半以上的人口年龄在 25 岁以下年龄。 10-24岁的男性和女性，被联合国人口基金（人口基金）定义为“年轻人”，占 sSA 人口的三分之一，而且这一比例还在继续增长。南苏丹的年轻女性经济和教育上处于不利地位的人从事性交易的风险很高。性工作者 16 岁以下的新从事性工作的人比年长的同事更容易遭受暴力、性传播感染和艾滋病毒的侵害。作为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。有关解决问题的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程度有限，但干预措施地址 YWHR 几乎不存在。为了响应 RFA-MH-17-560，我们提议使用 R34 来开发对未感染艾滋病毒的 15 至 24 岁女性进行综合干预，包括 PrEP 和艾滋病毒自我检测他们在乌干达坎帕拉从事高风险性活动，并进行试点试验以评估其可行性，对 PrEP 的接受和依从性以及重复 HIV 自我检测的可接受性和潜在影响。我们将将此研究嵌入我们现有的队列研究（NIMH R01 HD085805-01，PI King）中，该研究揭示了鉴于早期成果，需要在年轻性工作者刚进入该行业后立即给予更多关注在我们的动员努力中，艾滋病毒感染率远远高于预期。干预将重点是通过加强依从性支持来增加 PrEP 的启动，通过自我重复进行 HIV 检测测试以及采取和维持性传播感染、艾滋病毒和计划外性风险降低行为的动机怀孕。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，以及从事高风险性行为的女性（15-24 岁）的背景乌干达坎帕拉的行为以及 PrEP 的采用、坚持和重复的障碍和机会通过自检进行艾滋病毒检测； (2) 制定并测试社会和文化上可接受且可行的预防措施对艾滋病毒高危年轻女性采取和坚持 PrEP 和艾滋病毒自我检测进行干预； (3) 至将试点研究中吸取的经验教训转化为更大的随机对照试验的设计。拟议的项目是响应式的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青少年艾滋病毒预防。我们的提案代表了开发一种综合生物行为结构方法在资源匮乏的高危年轻女性中预防艾滋病毒有限的设置。