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

乌干达变性女性同伴提供的艾滋病毒自我检测、性传播感染自我采样和暴露前预防

基本信息

批准号：
9981832
负责人：
Andrew Mujugira
金额：
$ 17.27万
依托单位：
INFECTIOUS DISEASES INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9981832
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Adherence Adult Africa South of the Sahara African Anti-Retroviral Agents Caring Cellular Phone Characteristics Chlamydia trachomatis Clinic Clinic Visits Clinical Trials Cluster randomized trial Collaborations Collection Communities Data Decentralization Decision Making Disclosure Discrimination Effectiveness Enrollment Epidemic Ethics Evaluation Female Foundations General Population HIV HIV Infections HIV Seronegativity HIV risk Health Health Personnel Healthcare High Risk Woman Human immunodeficiency virus test Incidence Instruction Intervention Interview Joints Knowledge Low Prevalence Methodology Neisseria gonorrhoeae Oral Participant Partner Notification Peer Group Perception Persons Policies Population Population Research Positioning Attribute Prevalence Prevention Preventive Intervention Process Randomized Research Research Design Respondent Risk Role Sampling Services Sexual Partners Sexually Transmitted Diseases Specimen Stigmatization Testing Time Training Treatment Efficacy Uganda Underserved Population Urine Vulnerable Populations World Health Organization aged arm base behavior change beneficiary civil society effective intervention effectiveness testing efficacy testing experience health care service high risk improved innovation insight male member men who have sex with men novel peer peer networks pilot trial pre-exposure prophylaxis prevent prevention service primary outcome programs randomized trial recruit rectal screening service delivery sex sexual HIV transmission sexual risk behavior social social stigma testing services tool transgender transgender women transmission process treatment arm uptake

项目摘要

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.

项目摘要/摘要跨性别妇女（TGW）有艾滋病毒感染的高风险，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的HIV获取风险是其他15岁的成年人的13倍 49年。在乌干达，TGW的艾滋病毒患病率为22％，而普通人群为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测试（HIVST），STI自我采样（Stiss）和抗逆转录病毒前预防（PREP） - 对艾滋病毒阴性的那些人可能会降低HIV 非洲TGW的发病率。这项R34申请提案形成研究和试点试验，以开发非洲跨性别妇女的艾滋病毒预防干预（TGW）。我们将评估同行是否交付联合艾滋病毒预防增加了测试吸收，并使有效的预防决策在 TGW。同伴领导的干预措施可有效增加其他难以触及的艾滋病毒和性传播感染测试艾滋病毒患病率高但测试范围较低的脆弱人群，世界建议卫生组织。探索同行交付方法，以增加预防HIV组合的覆盖范围干预措施是解决HIV流行病控制中的研究差距的关键。但是，关于非洲TGW或为这个人群提供照顾的最佳方法。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）同龄人在创造重复测试和准备需求中的作用，以及3）如何优化联合HIV预防（HIVST，Stiss和Prep）的同伴递送。解决这些问题，该提案旨在进行格式研究，以告知同行分配的实施非洲TGW联合艾滋病毒预防（AIM 1），实施试验群集随机试验以评估同伴提供的艾滋病毒预防组合的可行性，可接受性和初步有效性（AIM 2）和进行深入的访谈，以探讨HIVST，Stiss和PrEP的同伴交付如何影响预防 TGW和性伴侣之间的选择（AIM 3）。据我们所知，这将是第一次评估的临床试验艾滋病毒在艾滋病毒未感染的TGW中进行自我测试和STI自采样。来自TGW及其合作伙伴的飞行员数据将提供独特的观点，以告知预防艾滋病毒。拟议的概念验证评估是独特的位置可改善非洲TGW的预防吸收 - 高风险，边缘化和服务不足人口。混合方法的严格应用将为策略和程序生成可行的数据，并为前沿组合艾滋病毒预防的可扩展实施提供了坚实的基础非洲TGW的干预措施。当地的跨性别社区参与了研究设计，计划和执行。该项目得到乌干达卫生部的支持。