Pharmacy-based PrEP for Young Women who Sell Sex in Zimbabwe

项目摘要 全球女性性工作者中艾滋病毒的流行率很高。东部和南部非洲10.4%， 33.3%的FSW是艾滋病毒感染者。在津巴布韦，FSW的流行率估计在一些国家高达78%， 地区和发病率估计为每年5-10%（更普遍地说，是成年妇女的10倍以上）， 年轻妇女和最近从事性工作的妇女发病率最高。模型显示 高吸收和持续暴露前预防（PrEP）可能会降低艾滋病毒的发病率 在新南威尔士州减少了40%，这不仅对它本身至关重要，而且对流行病控制也至关重要。模型还表明，40-80%的 到2035年，撒哈拉以南非洲的所有新感染病例都可能直接或间接归因于传播， 性交易的结果。 尽管PrEP非常有效，示范项目表明PrEP是可行的， 在非洲的FSW中，大多数开始PrEP的性工作者在最初的几年内停止服用 由于结构和行为障碍的混合，几个月。其中许多障碍都有可能得到解决 通过利用心理社会支持、行为经济学和结构性问题的干预措施。 我们建议共同开发和评估一项干预措施，通过以下方式直接解决PrEP持续不良的问题： 基于药房的干预措施，旨在增加PrEP的获得机会并减少其使用的耻辱。如果 成功，这项初步研究将铺平道路，为未来的有效性试验，以评估这种干预措施 更全面地。使用参与式过程，我们将与药房业主合作， FSW设计安全方便的空间，用于与艾滋病毒自我检测（HIVST）捆绑在一起的PrEP补充拾取 礼品卡激励（目标1）;然后，我们将通过以下方式在启动PrEP的妇女中试行干预措施： CeSHHAR现有的姐妹篇与语音程序，以评估在7个月的PrEP保留的影响（目的 2）;最后，使用实施科学方法，我们将使用混合方法来了解潜力 以FSW为重点的药房计划的规模，并根据调查结果，将吸取的经验教训转化为 未来有效性试验的设计（目标3）。 这项拟议的研究将探讨药店是否可以用来在FSW之间分发PrEP补充剂。如果 有效的干预措施可以适用于其他PrEP用户和新的PrEP技术，因为它们 变得可用。结果将为基于药店的PrEP服务的可接受性提供指导， 将PrEP与HIVST和礼品卡激励捆绑在一起，以及基于药店的分配是否可行， 是可以接受的，也是值得未来发展的。

Project Summary Global prevalence of HIV among female sex workers (FSW) is high. In Eastern and Southern Africa 10.4% and 33.3% of FSW are HIV infected. In Zimbabwe, prevalence estimates among FSW are as high as 78% in some regions and incidence is estimated at 5-10% per annum (over 10 times that in adult women more generally), with incidence highest among younger women and those recently engaged in sex work. Modelling suggests that with high uptake and continuation pre-exposure prophylaxis (PrEP) could potentially reduce HIV incidence in FSW by 40%, critical for its own sake but also for epidemic control. Modelling also suggests that 40-80% of all new infections in sub-Saharan Africa by 2035 are likely directly or indirectly attributable to transmission as a result of selling sex. Although PrEP is highly effective and demonstration projects show that PrEP is feasible to deliver and acceptable among FSW in Africa, the majority of sex workers who initiate PrEP stop taking it within the first few months due to a mix of structural and behavioral barriers. Many of these barriers can potentially be addressed through interventions that leverage psychosocial support, behavioral economics and structural issues. We propose to co-develop and evaluate an intervention to directly tackle poor PrEP continuation through a pharmacy-based intervention designed to increase access to PrEP and reduce stigma around its use. If successful, this preliminary study will pave the way for a future effectiveness trial to evaluate this intervention more comprehensively. Using a participatory process, we will work collaboratively with pharmacy owners and FSW to design safe and convenient spaces for PrEP refill pick-ups bundled with HIV self-testing (HIVST) and a gift card incentive (Aim 1); we will then pilot the intervention among women initiating PrEP through CeSHHAR’s existing Sisters with a Voice program to evaluate the impact on PrEP retention at 7 months (Aim 2); finally, using an implementation science approach, we will use mixed-methods to understand the potential for scale of the FSW-focused pharmacy program, and based on the findings, translate lessons learned into the design of a future effectiveness trial (Aim 3). The proposed study will explore whether pharmacies can be used to distribute PrEP refills among FSW. If effective the intervention could be adapted for other PrEP users and for new PrEP technologies as they become available. The results will provide guidance on the acceptability of pharmacy-based PrEP services, bundling PrEP with HIVST and a gift card incentive, and whether pharmacy-based distribution is feasible, acceptable, and worthy of future development.