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

为南非年轻女性设计和实施艾滋病毒综合预防

• 批准号: 9319819
• 负责人: Linda-Gail Gail Bekker
• 金额: $ 69.32万
• 依托单位: DESMOND TUTU HIV FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-07 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9319819
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adoption; African; Age; Behavior; Behavioral; Blinded; Cellular Phone; Characteristics; Communication; Counseling; Couples; Development; Effectiveness; Enrollment; Evaluation; Future; HIV; HIV risk; Habits; Human immunodeficiency virus test; Incentives; Incidence; Intention; Intervention; Knowledge; Male Circumcision; Medical; Modeling; Motivation; Oral; Outcome; Perception; Pharmaceutical Preparations; Prevention; Prevention strategy; Preventive Intervention; Qualitative Methods; Random Allocation; Reaction; Research; Rewards; Risk; Risk Assessment; Risk Reduction; Role; South Africa; South African; Surveys; Tenofovir; Testing; Woman; antiretroviral therapy; arm; base; behavioral economics; cohort; condoms; design; effective intervention; evidence base; improved; information framework; male; men; novel strategies; outreach; pill; placebo controlled study; pre-exposure prophylaxis; programs; public health relevance; randomized trial; risk perception; skills; social; therapy design; tool; treatment adherence; uptake; young man; young woman

 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.

 描述（由适用提供）：南非的年轻妇女的年度艾滋病毒事件为6-10％，是预防HIV联合HIV的高优先级，包括HIV测试，避孕套和降低风险咨询，伴侣HIV艾滋病毒测试，适度的现金转移和口服预防前预防（PREP）。 PREP已证明效率（在随机试验中为44-75％，> 90％，依从性高90％），并且是用户控制的，但在两项盲目的安慰剂对照的PREP试验中，年轻的非洲妇女的依从性很低，导致在非常高的HIV事件中没有证明有效性。这些结果引发了女性预防艾滋病毒的关键问题，即对艾滋病毒的低收入风险感知，安慰剂对照试验缺乏动力，每天服用药丸，伴侣支持或缺乏或预防艾滋病毒的兴趣较低。向南非年轻妇女提供预防联合组合的计划需要更好地理解促使她们使用联合预防的原因，他们如何识别自己的风险，评估证据并将其应用于采用预防策略。我们将对妇女如何理解自己的风险和亲密伴侣的作用进行形成性研究，我们假设是意图，动机，采用和遵守艾滋病毒预防策略的核心决定者。对于定性探究和行为经济学（BE），我们将使用信息动机 - 行为 - 行为（IMB）技能模型的免费框架进行定量方法，以识别杠杆以改变预防决策并制定实用的消息传递和干预措施。我们将在南非开普敦的年轻艾滋病毒阴性妇女中使用定性方法和实验性HIV风险小插图调查，以评估采用HIV预防干预措施的风险感知和动机。调查结果将为开发试点干预措施的开发，旨在提供概念证明，即基于更好地沟通的风险和伴侣参与设施预防组合的干预措施，包括PREP，以及在存在可检测的PREP药物水平的情况下进行有条件的短暂的适度现金激励，这将增强女性在启动Prep的女性中持续的依从性。将在开普敦的100名HIV阴性妇女的队列中评估改善艾滋病毒风险评估和伴侣预防艾滋病毒预防采用艾滋病毒的干预措施。我们的具体目的是：目标1：有关男性伴侣，相关社会因素和图案的形成性研究，这些研究促进了年轻的南非妇女对艾滋病毒预防的吸收和遵守。 AIM 2：测试南非年轻妇女的伴侣的试点策略，并评估伴侣测试是否与妇女的预防吸收有关。 AIM 3：使用有关风险评估和其他图案的研究发现，在年轻的南非妇女中实施预防干预措施，并评估这些干预措施与短期CCI是否会在存在或缺乏伴侣参与的情况下增强预期吸收和依从性。这些知识差距必须解决以后的生物医学预防策略的试验，并对预防联合预防的实施以及对非洲年轻妇女的有效干预措施。