Design and delivery of combination HIV prevention in young South African women

 描述（由申请人提供）：南非的年轻女性每年的艾滋病毒发病率为6 - 10%，是艾滋病毒预防组合的高度优先群体，包括艾滋病毒检测，避孕套和降低风险咨询，伴侣艾滋病毒检测，适度的现金转移和口服暴露前预防（PrEP）。PrEP已证明有效性（随机试验中为44 - 75%，高依从性> 90%），并且是用户对照的，但在两项盲法安慰剂对照试验中，年轻的非洲妇女对PrEP的依从性非常低，导致在非常高的艾滋病毒发病率的背景下没有表现出有效性。这些结果提出了妇女艾滋病毒预防的关键问题，如对艾滋病毒感染风险低的看法，在安慰剂对照试验中缺乏动力，每日服用避孕药的障碍，伴侣支持或缺乏，或对艾滋病毒预防的兴趣低。向南非年轻妇女提供综合预防的方案需要更好地了解是什么促使她们使用综合预防，她们如何认识到自己的风险，评估证据并将其应用于采取预防战略。我们将进行形成性研究，了解妇女如何理解她们的风险和亲密伴侣的作用，我们假设，这是意图，动机，采用和坚持艾滋病毒预防战略的核心决定因素。我们将使用信息-动机-行为（IMB）技能模型的补充框架进行定性调查，并使用行为经济学（BE）进行定量方法，以确定改变预防决策的杠杆，并制定实用的信息和干预措施。我们将在南非开普敦艾滋病毒阴性的年轻妇女中使用定性方法和实验性艾滋病毒风险小插曲调查，以评估风险认知和采取艾滋病毒预防干预措施的动机。研究结果将为试点干预措施的开发提供信息，该干预措施旨在提供概念证明，即基于更好地沟通风险和合作伙伴参与的干预措施有助于采取包括PrEP在内的组合预防，以及以可检测的PrEP药物水平为条件的短期适度现金激励，将提高妇女开始PrEP的持久坚持。干预措施，以改善艾滋病毒风险评估和合作伙伴参与艾滋病毒预防收养，包括CCI的PrEP依从性，将在开普敦的100名HIV阴性妇女的队列中进行评估。我们的具体目标是：目标1：对促进南非年轻妇女接受和坚持艾滋病毒预防的男性伴侣、相关社会因素和激励因素进行形成性研究。目标二：对南非青年妇女的伴侣进行检测的试点战略，并评价伴侣检测是否与妇女接受预防措施有关。目标3：在年轻的南非妇女中实施预防干预，使用有关风险评估和其他激励因素的研究结果，并评估这些干预措施与短期CCI一起是否会在存在或不存在伴侣参与的情况下提高PrEP的吸收和坚持。在今后试验生物医学预防战略和对非洲青年妇女实施预防与有效干预相结合时，必须解决这些知识差距。

 DESCRIPTION (provided by applicant): Young women in South Africa have an annual HIV incidence of 6-10% and are a high priority group for combination HIV prevention, including HIV testing, condoms and risk reduction counseling, partner HIV testing, modest cash transfers and oral pre-exposure prophylaxis (PrEP). PrEP has demonstrated efficacy (44-75% in randomized trials, >90% with high adherence) and is user-controlled, yet young African women in two blinded, placebo-controlled trials of PrEP had very low adherence, resulting in no demonstrated effectiveness in the context of very high HIV incidence. These results raise key questions for HIV prevention in women about perception of low HIV acquisition risk, lack of motivation in a placebo-controlled trial, barriers to taking a daily pill, partner support or lack, or low interestin HIV prevention. Programs that deliver combination prevention to young South African women need a better understanding of what motivates them to use combination prevention, how they recognize their risk, evaluate evidence and apply this to adoption of prevention strategies. We will conduct formative research about how women understand their risks and the role of intimate partners, which we hypothesize, are central determinants of intention, motivation, adoption of and adherence to HIV prevention strategies. We will use complimentary frameworks of the Information-Motivations-Behavior (IMB) skills model for qualitative inquiry and behavioral economics (BE) for quantitative approaches to identify levers to change prevention decisions and develop practical messaging and interventions. We will use qualitative methods and experimental HIV risk vignette surveys among young HIV-negative women in Cape Town, South Africa to assess risk perception and motivations to adopt HIV prevention interventions. Findings will inform development of a pilot intervention designed to provide proof of concept that an intervention based on better communication about risk and partner engagement facilitates uptake of combination prevention including PrEP, and a short-lived modest cash incentive conditional on presence of detectable PrEP drug levels, will enhance persistent adherence among women initiating PrEP. The intervention to improve HIV risk evaluation and partner involvement for HIV prevention adoption, including CCI for PrEP adherence, will be evaluated in a cohort of 100 HIV-negative women in Cape Town. Our Specific Aims are to: Aim 1: Conduct formative research about male partners, related social factors and motivators that facilitate young South African women's uptake of and adherence to HIV prevention. Aim 2: Pilot strategies for testing the partners of young South African women and evaluate whether partner testing is associated with uptake of prevention by women. Aim 3: Implement a prevention intervention among young South African women using research findings about risk evaluation and other motivators and assess whether these interventions together with short-term CCI will enhance PrEP uptake and adherence in the presence or absence of partner involvement. These knowledge gaps must be addressed for future trials of biomedical prevention strategies and implementation of combination prevention with effective interventions for young African women.