Evaluation of the Implementation of PrEP Provision for Ugandan Fisherfolk

对乌干达渔民 PrEP 规定实施情况的评估

• 批准号: 10382315
• 负责人: Laura M Bogart
• 金额: $ 16.1万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10382315
• 关键词: AIDS prevention; Africa South of the Sahara; Ambulatory Care Facilities; Area; Awareness; Boat; Businesses; Caring; Characteristics; Clinic; Communities; Community Health Aides; Community Healthcare; Country; Data; Epidemic; Evaluation; Event; Family; Fisheries; Fishes; Funding; Future; Gender; General Population; Goals; Government; HIV; HIV Seronegativity; HIV Seropositivity; HIV antiretroviral; Health; Health Personnel; Health care facility; Healthcare; Home; Hour; Human immunodeficiency virus test; Hybrids; Incidence; Individual; Intervention; Interview; Island; Labor Forces; Laboratories; Medical Records; Methods; Modeling; Persons; Policies; Population; Populations at Risk; Prevalence; Prevention Guidelines; Prostitution; Protocols documentation; Public Health Schools; Qualitative Research; Research; Rivers; Schedule; Secure; Series; Site; Specific qualifier value; Structure; Subgroup; Tenofovir; Testing; Time; Uganda; United States National Institutes of Health; Universities; Vendor; Work; acceptability and feasibility; aged; antiretroviral therapy; base; community clinic; cost; emtricitabine; feasibility testing; health care availability; high risk; home test; implementation evaluation; implementation intervention; intervention delivery; meetings; migration; outreach; pill; pre-exposure prophylaxis; prevent; programs; sociodemographics; treatment comparison; treatment guidelines; treatment organization; uptake; working group

PROJECT SUMMARY In Ugandan fisherfolk communities, HIV prevalence is an order of magnitude higher than in the Ugandan general population, and high HIV prevalence among fisherfolk helps to drive the general epidemic. In a prior R21 study, we demonstrated that bringing HIV testing to fisherfolk communities, where healthcare facilities are scarce, can identify a large number of high-risk HIV-negative fisherfolk. To have a significant impact on the HIV epidemic among fisherfolk, a key next step in this research program would be to offer pre-exposure prophylaxis (PrEP; a highly effective and safe daily pill containing tenofovir and emtricitabine to prevent HIV) to high-risk HIV-negative fisherfolk following HIV testing. Although the 2016 Ugandan HIV prevention and treatment guidelines recommend PrEP for HIV prevention in fisherfolk, there is currently no governmental support for PrEP implementation in fisherfolk communities. Pilot data are urgently needed to demonstrate to the Ugandan Ministry of Health that PrEP can be feasibly delivered to fisherfolk, in order to secure government support for PrEP for fisherfolk. The Specific Aims are: (1) To conduct formative qualitative research to examine barriers to and facilitators of PrEP uptake, and to obtain input on acceptable PrEP messaging and provision, for fisherfolk communities on Lake Victoria, Uganda; and (2) To conduct a mixed-methods analysis comparing the implementation of community-based vs. healthcare facility-based PrEP provision for fisherfolk communities on Lake Victoria, Uganda. For both PrEP interventions, we will conduct monthly HIV testing and PrEP and antiretroviral treatment provision events, using messages developed from the formative work to raise awareness about PrEP. PrEP will be offered to 100 fisherfolk in two Lake Victoria landing sites during testing events on specified days of the month: In one site, PrEP will be distributed in a nearby healthcare facility during monthly events, and in the other site, PrEP will be distributed in a temporary community space. Among those who are non-adherent (based on refill data), PrEP provision will be supplemented via PrEP delivery by community health workers or at community PrEP pick-up points, based on strategies elicited in the formative work. To evaluate implementation, we will conduct semi-structured interviews with healthcare providers and fisherfolk who do and do not decide to initiate PrEP, and obtain medical records data to compare the proportion of fisherfolk: identified as PrEP-eligible, who initiate PrEP, who adhere to PrEP (i.e., refills over 6 mos.), who seroconvert, and who discontinue PrEP, overall and by socio-demographic characteristics (e.g., gender). We will engage with Ugandan Ministry of Health policymakers throughout the research, to keep them apprised of results and to determine directions for future policy around PrEP for fisherfolk. To realize the 90- 90-90 goals, it is critical to seek out the hardest to reach, most at-risk populations such as fisherfolk, who reside and work in areas without easy access to healthcare.

项目摘要 在乌干达的黑人社区，艾滋病毒流行率比乌干达的黑人社区高一个数量级。 艾滋病毒在一般人群中的流行率很高，这有助于推动普遍流行。在现有 R21研究，我们证明，将艾滋病毒检测带到社区，那里的医疗机构 稀缺，可以确定大量的高风险艾滋病毒阴性艾滋病患者。对艾滋病病毒产生重大影响 流行病在美国人中，这项研究计划的关键下一步将是提供预先暴露 预防（PrEP;一种高效安全的每日药丸，含有替诺福韦和恩曲他滨，用于预防HIV）， 艾滋病毒检测后艾滋病毒阴性的高危人群。尽管2016年乌干达艾滋病毒预防和 治疗指南建议PrEP用于艾滋病毒预防，目前没有政府 * 支持在土著社区实施预防性教育方案。迫切需要试点数据来证明， 乌干达卫生部认为，为了确保政府的安全， 为残疾人提供PrEP支持。具体目的是：（1）进行形成性质的研究， 采取PrEP的障碍和促进因素，并获得关于可接受的PrEP信息传递和提供的投入， 为乌干达维多利亚湖上的土著居民社区;（2）进行混合方法分析， 实施以社区为基础与以医疗机构为基础的PrEP，为社区提供 在乌干达的维多利亚湖。对于这两种PrEP干预措施，我们将每月进行艾滋病毒检测和PrEP， 提供抗逆转录病毒治疗的活动，利用从形成工作中产生的信息， 在测试期间，将向维多利亚湖两个着陆点的100名美国人提供PrEP 在一个月的指定日期发生的事件：在一个研究中心，PrEP将在一个月内分发到附近的医疗机构。 每月举办一次活动，而在另一个地点，PrEP将在临时社区空间分发。人中 不依从者（基于补充数据），PrEP供应将通过PrEP交付补充， 社区卫生工作者或社区PrEP拾取点，基于形成中引出的策略， 工作为了评估实施情况，我们将与医疗保健提供者进行半结构化访谈， 做和不决定启动PrEP的人，并获得医疗记录数据，以比较 患者比例：确定为符合PrEP条件，启动PrEP，坚持PrEP（即，笔芯超过6个 莫斯。），谁血清转化，谁停止PrEP，总体和社会人口统计学特征（例如， 性别）。我们将在整个研究过程中与乌干达卫生部的决策者接触， 评估结果，并确定未来政策的方向，围绕PrEP为残疾人。为了实现90- 90-90个目标，关键是要找出最难接触，最危险的人群，如非裔美国人，他们 在难以获得医疗保健的地区居住和工作。