IPrEP: A Combination HIV Prevention Strategy for Young Women at Risk for HIV

IPrEP：针对面临艾滋病毒风险的年轻女性的艾滋病毒综合预防策略

• 批准号: 9983145
• 负责人: Kawango Agot
• 金额: $ 44.7万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-22 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9983145
• 关键词: AIDS prevention; Address; Adherence; Affect; Africa South of the Sahara; Age-Years; Area; Attention; Attitude; Behavior Therapy; Behavioral; Biological; Client; Collaborations; Cost Effectiveness Analysis; Counseling; Country; Discipline of Nursing; Effectiveness; Epidemic; Epidemiology; Evidence based intervention; Face; Feasibility Studies; Financial compensation; Funding; Gatekeeping; General Population; Geography; Goals; Government; HIV; HIV Infections; HIV prevention trial; HIV risk; Health Personnel; Heterosexuals; Human immunodeficiency virus test; Incidence; Individual; Infection; Infrastructure; Injecting drug user; Internet; Intervention; Intervention Studies; Interview; Kenya; Knowledge; Life; Light; Link; Measures; Men' s Role; Methods; Motivation; Nursing Education; Nursing Faculty; Nursing Staff; Nursing Students; Oral; Perception; Pharmaceutical Preparations; Play; Population; Populations at Risk; Prevalence; Prevention; Prevention approach; Prevention program; Prevention strategy; Preventive Intervention; Public Health; Qualitative Research; Randomized Controlled Trials; Research; Research Design; Research Priority; Research Project Grants; Resistance development; Resources; Risk; Risk Behaviors; Risk Reduction; Series; Sexual Partners; Social Network; Structure; Study models; Universities; Vulnerable Populations; Woman; Work; behavioral adherence; brief intervention; cohort; community organizations; compare effectiveness; cost effectiveness; design; economic evaluation; effectiveness evaluation; efficacy study; evidence base; experience; female sex worker; health assessment; high risk; implementation research; implementation science; innovation; male; men; men who have sex with men; neglect; organizational structure; peer support; pre-exposure prophylaxis; preference; prevention service; programs; public health relevance; recruit; risk perception; scale up; sex; side effect; social; stem; transmission process; uptake; willingness; young woman

 DESCRIPTION (provided by applicant): Key populations within the generalized HIV epidemic in sub-Saharan Africa (SSA) have received insufficient attention including female sex workers (FSWs), a group with HIV prevalence substantially higher than the general population and a major contributor to the HIV epidemic in Kenya. Young FSWs (18-24 years old), a vulnerable population, are at highest risk among FSWs and require tailored biomedical, behavioral and structural interventions to counter the epidemiological and contextual complexities they face. We propose the IPrEP Research Project which includes: 1) formative research, inclusive of qualitative research among young FSWs, male clients (MCs) to elucidate life challenges, motivations and perceptions of HIV risks; risk behaviors; knowledge, attitudes about HIV and HIV prevention, including PrEP; preferences for adherence support; and sex partner relations. Interviews with health care providers (HCPs) will assess knowledge regarding HIV prevention and PrEP and attitudes towards FSWs; 2) an enhanced oral pre-exposure prophylaxis (PrEP) study among young FSWs to determine the uptake, adherence, feasibility and acceptability of combination strategy of PrEP, a biomedical intervention, with behavioral and structural adherence interventions (peer support versus reminders and resource transfer) and risk-reduction counseling intervention; 3) feasibility study for recruitment and retention of MCs with assessment of acceptability of risk-reduction counseling intervention; 4) cost-effectiveness analysis in collaboration with University of Nairobi (UoN) of the combination PrEP strategies to inform implementation and scale-up and 5) capacity building in implementation research for nurse faculty and students at UoN building on PEPFAR Nursing Education Partnership Initiative (NEPI) experience and infrastructure. The proposed research is distinguished by several innovations, including focus on young FSW, a population a high risk in a geographic HIV hotspot in Kenya, as well as on MCs and HCPs who play key roles in access by FSWs to prevention services and to prevention methods. The research includes implementation of theoretically- driven combination prevention strategies inclusive of biomedical, behavioral and structural interventions and an intervention aimed to decrease sexual risk compensation and risk behaviors; the assessment of HCPs' knowledge and attitudes regarding HIV prevention, including PrEP, and FSWs; cost-effectiveness analysis to inform implementation and scale-up within PEPFAR-supported programs, as well as a commitment to building capacity to design, implement and analyze findings from implementation studies working with nursing partner. The ultimate goal of our research is to identify how PrEP can be effectively implemented for this young population at substantial risk for HIV decreasing their risk of HIV acquisition, consequently diminishing the overall number of new HIV infections in Kenya and similar settings. Findings from this research will also inform PEPFAR as it aims to stem the spread of HIV through the effective use of evidence-based interventions.

 描述（由申请人提供）：撒哈拉以南非洲（SSA）普遍艾滋病毒流行的关键人群没有受到足够的关注，其中包括女性性工作者（FSW），这一群体的艾滋病毒感染率远高于一般人群，也是肯尼亚艾滋病毒流行的主要贡献者。年轻的 FSW（18-24 岁）是一个弱势群体，在 FSW 中风险最高，需要量身定制的生物医学、行为和结构干预措施，以应对他们面临的流行病学和背景复杂性。我们提出 IPrEP 研究项目，其中包括：1) 形成性研究，包括对年轻 FSW、男性客户 (MC) 进行定性研究，以阐明生活挑战、动机和对艾滋病毒风险的看法；危险行为；关于艾滋病毒和艾滋病毒预防（包括 PrEP）的知识和态度；依从性支持的偏好；和性伴侣关系。与卫生保健提供者 (HCP) 的访谈将评估有关艾滋病毒预防和 PrEP 的知识以及对 FSW 的态度； 2) 一项针对年轻 FSW 的强化口服暴露前预防 (PrEP) 研究，以确定 PrEP（一种生物医学干预措施）与行为和结构依从性干预措施（同伴支持与提醒和资源转移）以及降低风险咨询干预措施的结合策略的采用、依从性、可行性和可接受性； 3) 招募和保留 MC 的可行性研究，评估降低风险咨询干预的可接受性； 4) 与内罗毕大学 (UoN) 合作，对组合 PrEP 策略进行成本效益分析，为实施和扩大规模提供信息；5) 基于 PEPFAR 护理教育伙伴计划 (NEPI) 的经验和基础设施，为 UoN 的护士教职员工和学生进行实施研究的能力建设。 拟议的研究以多项创新为特色，包括关注年轻的 FSW（肯尼亚艾滋病毒热点地区的高危人群），以及在 FSW 获得预防服务和预防方法方面发挥关键作用的 MC 和 HCP。该研究包括实施理论驱动的组合预防策略，包括生物医学、行为和结构干预措施以及旨在减少性风险补偿和风险行为的干预措施；评估 HCP 对 HIV 预防（包括 PrEP）和 FSW 的知识和态度；成本效益分析，为 PEPFAR 支持的计划的实施和扩大提供信息，并致力于建设设计、实施和分析与护理合作伙伴合作的实施研究结果的能力。 我们研究的最终目标是确定如何为这些面临艾滋病毒高风险的年轻人有效实施 PrEP，降低他们感染艾滋病毒的风险，从而减少肯尼亚和类似地区新发艾滋病毒感染的总数。这项研究的结果还将为总统防治艾滋病紧急救援计划提供信息，因为该计划旨在通过有效利用循证干预措施来阻止艾滋病毒的传播。