Peer-Delivered HIV Self-Testing, STI Self-Sampling and PrEP for Transgender Women in Uganda

项目摘要/摘要 变性人妇女(TGW)感染艾滋病毒的风险很高，是一个重要的、研究不足的人群。 在撒哈拉以南非洲。在全球范围内，TGW人群感染艾滋病毒的风险是其他15岁成年人的13倍- 49年了。在乌干达，TGW中的艾滋病毒流行率为22%，而普通人群中的艾滋病毒流行率为5.9%。 鼓励使用自我控制的艾滋病毒预防工具--特别是艾滋病毒自我检测(HIVST)、性传播感染自我抽样 (STISS)和抗逆转录病毒暴露前预防(PrEP)-对艾滋病毒检测阴性的人可能会减少艾滋病毒 非洲TGW的发病率。此R34应用程序建议进行形成性研究和试点试验，以开发 非洲变性妇女艾滋病毒预防干预(TGW)。我们将评估是否同行交付 艾滋病毒联合预防增加了检测接受率，并使有效的预防决策成为可能 TGW。同行领导的干预措施有效地增加了艾滋病毒和性传播感染检测以及其他难以触及的因素 艾滋病毒感染率高但检测覆盖率低的弱势人群，世界推荐 卫生组织。探索同伴接生方法以增加艾滋病毒联合预防的覆盖率 干预措施是弥补艾滋病毒流行控制研究空白的关键。然而，人们对此知之甚少 同行提供的艾滋病毒联合预防(HIVST、STISS和PrEP)对非洲TGW的有效性 为这些人群提供护理的最佳方式。关键知识差距包括：1)同行交付是否增加 测试率和状态知识，2)同行在创造重复测试和PrEP需求方面的作用，以及3) 如何优化组合HIV预防的同伴交付(HIVST、STISS和PrEP)。要解决这些问题 问题，这项建议试图进行形成性研究，为同行交付的实施提供信息 非洲TGW艾滋病毒预防组合(目标1)，实施试点整群随机试验，以评估 同伴联合预防艾滋病毒的可行性、可接受性和初步有效性(目标2)；以及 进行深入访谈，探讨HIVST、STISS和PrEP的同行交付如何影响预防 TGW和性伴侣之间的选择(目标3)。据我们所知，这将是第一次临床试验 未感染HIV的TGW的HIV自我检测和STI自我采样。来自TGW及其合作伙伴的试点数据将 提供独特的视角，为艾滋病毒预防工作的开展提供信息。拟议的概念验证评估是 独特的定位，可提高非洲TGW的预防能力--一种高风险、边缘化和服务不足的群体 人口。混合方法的严格应用将为政策和方案产生可操作的数据， 为可扩展实施尖端组合艾滋病预防提供了坚实的基础 对非洲TGW的干预。当地的变性人社区参与了研究设计、规划和 实施。该项目得到乌干达卫生部的支持。

PROJECT SUMMARY/ABSTRACT Transgender women (TGW) are at high risk for HIV infection, and are an important, under-researched population in sub-Saharan Africa. Globally, HIV acquisition risk among TGW is 13 times higher than other adults aged 15- 49 years. In Uganda, HIV prevalence among TGW is 22% compared to 5.9% in the general population. Encouraging use of self-controlled HIV prevention tools – specifically, HIV self-testing (HIVST), STI self-sampling (STISS) and antiretroviral pre-exposure prophylaxis (PrEP) - to those testing HIV negative could decrease HIV incidence among African TGW. This R34 application proposes formative research and a pilot trial to develop an HIV prevention intervention for African transgender women (TGW). We will evaluate whether peer-delivered combination HIV prevention increases testing uptake and empowers effective prevention decision making in TGW. Peer-led interventions are effective in increasing HIV and STI testing among other hard-to-reach vulnerable populations with high HIV prevalence but low testing coverage, and are recommended by the World Health Organization. Exploring peer-delivery approaches to increase coverage of combination HIV prevention interventions is key to addressing research gaps in HIV epidemic control. However, little is known about the effectiveness of peer-delivered combination HIV prevention (HIVST, STISS and PrEP) for African TGW, or the best way to deliver care to this population. Key knowledge gaps include: 1) whether peer delivery increases testing rates and status knowledge, 2) the role of peers in creating demand for repeat testing and PrEP, and 3) how to optimize peer delivery of combination HIV prevention (HIVST, STISS and PrEP). To address these questions, this proposal seeks to conduct formative research to inform implementation of peer-delivered combination HIV prevention for African TGW (Aim 1), implement a pilot cluster randomized trial to evaluate the feasibility, acceptability and preliminary effectiveness of peer delivered combination HIV prevention (Aim 2), and conduct in-depth interviews to explore how peer-delivery of HIVST, STISS and PrEP influences prevention choices among TGW and sexual partners (Aim 3). This will be the first clinical trial, to our knowledge, to evaluate HIV self-testing and STI self-sampling in HIV-uninfected TGW. Pilot data from TGW and their partners will provide unique perspectives to inform HIV prevention delivery. The proposed proof-of-concept evaluation is uniquely positioned to improve prevention uptake for African TGW - a high-risk, marginalized, and underserved population. Rigorous application of mixed methodologies will generate actionable data for policy and programs, and provide a strong foundation for scalable implementation of cutting edge combination HIV prevention interventions for African TGW. The local transgender community is involved in study design, planning and implementation. This project is supported by the Ugandan Ministry of Health.