Multilevel Comprehensive HIV Prevention for South African Adolescent Girls and Young Women

南非少女和年轻妇女的多层次综合艾滋病毒预防

• 批准号: 10229121
• 负责人: GERI R DONENBERG
• 金额: $ 81.48万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10229121
• 关键词: 18 year old; 19 year old; AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adopted; Africa; Africa South of the Sahara; Alcohol consumption; Area; Behavior; Biomedical Technology; Caregivers; Caring; Continuity of Patient Care; Cost Control; Counseling; Data; Decision Making; Discrimination; Drug usage; Economics; Educational Curriculum; Effectiveness; Epidemic; Epidemiology; Evaluation; Evidence based intervention; Failure; Family; Female; Female Adolescents; Foundations; Generations; Goals; Government; HIV; HIV Infections; HIV risk; HIV/STD; Health; Health Promotion; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Mediator of activation protein; Mental disorders; Methodology; Modeling; Outcome; Phase; Pilot Projects; Politics; Prevalence; Prevention; Prevention program; Primary Prevention; Process; Public Health; Reporting; Research; Resources; Risk; Risk Behaviors; Safe Sex; Science; Services; Sex Behavior; Shapes; Site; South Africa; South African; Testing; Time; Woman; Youth; age group; arm; base; behavior change; compare effectiveness; condoms; cost; cost effectiveness; cost-effectiveness evaluation; data sharing; design; effectiveness evaluation; experience; follow-up; girls; high risk sexual behavior; improved; innovation; male; men; metropolitan; mortality; multidisciplinary; novel; peer; phase II trial; pre-exposure prophylaxis; prevent; programs; public health priorities; role model; sexual risk behavior; sexual risk taking; social culture; social stigma; social structure; stem; transmission process; uptake; young woman

ABSTRACT Reducing new HIV and STI infections among South African (SA) adolescent girls and young women (AGYW) is global public health priority.1 SA has world's largest HIV epidemic,2,3 and SA AGYW acquire HIV at twice the rate of and seroconvert on average 5 – 7 years earlier than male peers.3 As new infections continue to outpace access to and availability of PrEP and ART, primary prevention remains the most viable strategy to stem new transmissions.1,4,5 SA efforts to prevent HIV transmission in youth focus mostly on individual-level behavior change,6-8 but AGYW's persistent HIV disparities are explained by broad social and structural inequities that shape and constrain HIV-risk behaviors.9-14 Comprehensive HIV prevention packages that are integrated, synergistic, and tailored to the local epidemiology and cultural context are likely to achieve and sustain maximum reductions in HIV-risk.15-22 Female caregivers (FC) are an untapped resource in the HIV prevention toolbox23,24 and offer a novel opportunity to strengthen AGYW prevention efforts. AGYW may also be change agents for their FC who want to be positive role models for AGYW, and thus, adopt HIV prevention behaviors, including HTC and PrEP. Guided by an ecological framework, our highly experienced multidisciplinary team will adapt (phase 1/UG3) and evaluate the effectiveness and cost-effectiveness of (phase 2/UH3) IMARA, a multilevel, innovative, family-based HIV prevention program that targets individual, social, and structural drivers of risk to decrease HIV and STI incident infections, reduce risky sexual behavior, and increase HTC and PrEP uptake (where appropriate) in AGYW and FC. IMARA demonstrated a 45% reduction in incident STI at 12-month follow-up among black 14-18 year-old girls in the US, and increased HIV testing in FC. Pilot data with 71 AGYW and FC at the Desmond Tutu HIV Foundation (DTHF; study site) confirm feasibility and acceptability of IMARA for the South African context. This study will be integrated into the adolescent-friendly services at DTHF in the Western Cape metropolitan area facilitating sustainability if effective. Using the ADAPT-ITT model, we will systematically tailor IMARA for the SA context and then conduct a 2-arm RCT with 300 15-19 year-old AGYW and FC. FC and AGYW will complete baseline, 6-, and 12-month assessments, including testing for 3 STI. We will offer HTC and PrEP at each assessment and track uptake and linkage to care. AGYW and FC who test positive for a STI and/or HIV will receive free treatment at DTHF. We will collect data to determine the costs of IMARA. Analyses will compare AGYW and FC across the intervention and control programs on sexual risk taking, STI and HIV incidence, PrEP and HTC uptake, and theoretical mediators. The study answers an urgent need to evaluate the effectiveness and cost-effectiveness of combination HIV prevention packages for AGYW to achieve an AIDS-free generation.

摘要 减少南非（SA）少女和年轻妇女中新的艾滋病毒和性传播感染 1南非是世界上艾滋病毒流行最严重的国家，2、3 艾滋病毒感染率是男性同龄人的两倍，血清转化平均比男性同龄人早5 - 7年。 感染继续超过获得和可用的PrEP和ART，初级预防仍然是 1，4，5南非努力预防艾滋病毒在青年中的传播， 大多数是在个人层面上的行为改变，6-8，但AGYW的持续艾滋病毒的差异解释如下： 广泛的社会和结构性不平等影响和限制了艾滋病毒风险行为。 综合、协同和适合当地流行病学和文化的预防一揽子计划， 15-22女性照料者（FC） 艾滋病毒预防工具箱中尚未开发的资源23，24，并为加强AGYW提供了新的机会 预防工作。AGYW也可能是他们FC的变革推动者，他们希望成为积极的榜样， AGYW，因此，采取艾滋病毒预防行为，包括HTC和PrEP。 框架，我们经验丰富的多学科团队将适应（第1阶段/UG 3），并评估 一个多层次、创新的、以家庭为基础的艾滋病毒方案（第2期/UH 3期）的有效性和成本效益 针对个人、社会和结构性风险驱动因素的预防计划，以减少艾滋病毒和性传播感染 事件感染，减少危险的性行为，并增加HTC和PrEP吸收（在适当的情况下） 在AGYW和FC。在12个月的随访中，IMARA显示STI事件减少了45%， 美国14-18岁的黑人女孩，并增加了FC的艾滋病毒检测。71 AGYW和FC的试验数据， DesmondTutuHIV基金会（DTHF;研究中心）证实了IMARA用于 南非的背景。这项研究将纳入DTHF的方便残疾人服务中， 西开普大都市区如果有效，将促进可持续性。使用ADAPT-ITT模型，我们将 系统地为SA背景定制IMARA，然后对300名15-19岁的患者进行2组RCT AGYW和FC。FC和AGYW将完成基线、6个月和12个月评估，包括测试 3 STI。我们将在每次评估时提供HTC和PrEP，并跟踪吸收和与护理的联系。AGYW 而经性病及/或爱滋病病毒测试呈阳性的家庭佣工，可在DTHF接受免费治疗。我们将收集数据， 确定IMARA的成本。分析将比较干预组和对照组的AGYW和FC 关于性风险承担、性传播感染和艾滋病毒发病率、PrEP和HTC吸收以及理论中介的方案。 该研究回答了迫切需要评估的有效性和成本效益的组合 * 为青年志愿者协会提供艾滋病毒预防一揽子计划，以实现无艾滋病一代。