Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women

项目概要 我们的首要目标是遏制艾滋病毒流行及其对撒哈拉以南地区年轻人的负面影响 非洲（SSA）通过提高多层次组合艾滋病毒的吸收、保留和依从性 少女和年轻妇女以及男性伴侣的预防。南非估计有 7.8 万艾滋病毒感染者。尽管拥有世界上最大的艾滋病毒治疗计划，但艾滋病毒发病率 少女和年轻女性（AGYW 15-24 岁）的比例仍然很高。虽然已经有 HIV 预防方面的重大创新，例如普遍检测和治疗 (UTT) 和暴露前 预防（PrEP），这远远超过了提供它们的能力。控制艾滋病毒的流行是一项重要任务 迫切需要显着提高 AGYW 和男性对艾滋病毒护理和预防的接受和保留 合作伙伴。在这个项目中，我们有一个独特的机会来利用贫困和农村地区的时间敏感事件 夸祖鲁-纳塔尔省高流行区：推出八项新的以青年为重点的多层次艾滋病毒预防措施 PEPFAR 的“坚定、有弹性、赋权、无艾滋病”为 AGYW 及其男性伴侣提供干预措施， 在最先进的人口和健康背景下的指导和安全（DREAMS）计划 监测，其中有关个人艾滋病毒生物标志物、性行为、艾滋病毒预防和抗逆转录病毒治疗暴露的数据 与公共部门的艾滋病毒临床记录相关联。我们通过三个目标实现了这一目标。具体目标1：我们 量化了多个层面的社会动态如何相互作用来预测 DREAMS 成分的吸收。具体 目标 2：我们阐明了个人的生命历程和对梦想的接触如何影响对梦想的保留和坚持 艾滋病毒护理和预防。我们发现： a) 尽管覆盖率很高，DREAMS 并没有加速艾滋病毒的下降 发生率。 b) 艾滋病毒发病率下降的原因是男性获得艾滋病毒治疗的机会增加，尽管 对于年轻人来说，障碍仍然存在。 c) 性健康需求高度未得到满足，自我检测和自我取样 很受欢迎。 d) 有针对性的暴露前预防 (PrEP) 并未到达风险最大的 AGYW，而同行- 航海家做到了。具体目标 3：确定家庭和同伴网络策略是否可以提高人们的接受度和 年轻人坚持综合预防干预措施。我们与年轻人一起审问 调查结果并共同制定干预措施。结果，Thetha Nami（对我说话）由训练有素的和 受监督的同伴导航员向年轻人提供健康促进服务；青年友好型临床服务；和 同行指导，以提高艾滋病毒预防的保留率。我们目前正在测试可接受性和 这种方法在提高青少年接受和保留艾滋病毒护理方面的可行性 预防。我们的多学科团队包括艾滋病毒流行病学家、生物统计学家、社会学家 南非的科学家、心理学家和干预开发专业知识。展望未来，这将 提供以下问题的答案：“同伴和社区一级的干预措施能否充分利用死亡率和艾滋病毒发病率 降低了农村撒哈拉以南非洲地区青少年和年轻人的艾滋病毒预防潜力？

PROJECT SUMMARY Our overarching goal is to arrest the HIV epidemic and its negative impact on young people in sub-Saharan African (SSA) through improving the uptake, retention, and adherence of multi-level combination HIV prevention by Adolescent Girls and Young Women and male partners. South Africa has an estimated 7.8 million people living with HIV. Despite having the largest HIV treatment program in the world, HIV incidence in Adolescent Girls and Young Women (AGYW aged 15-24) remains high. Whilst there have been significant innovations in HIV prevention, e.g., universal test and treat (UTT) and Pre-exposure prophylaxis (PrEP), this has far outpaced the ability to deliver them. To control the HIV epidemic here is an urgent to significantly improve uptake and retention of HIV care and prevention by AGYW and male partners. In this project we had a unique opportunity to leverage time-sensitive events in a poor and rural hyperendemic area of KwaZulu-Natal: The roll out of eight new youth-focused multi-level HIV prevention interventions for AGYW and their male partners by PEPFAR’s Determined, Resilient, Empowered, AIDS free, Mentored, and Safe (DREAMS) program in the context of a state of the art demographic and health surveillance, where data on individual HIV biomarkers, sexual behaviors, HIV prevention and ART exposure are linked to public-sector clinical records for HIV. We achieved this through three aims. Specific aim 1: We quantified how multiple levels of social dynamics interact to predict uptake of DREAMS components. Specific aim 2: We elucidated how individuals’ life-course and exposure to DREAMS affect retention and adherence to HIV care and prevention. We found that: a) Despite high coverage, DREAMS did not accelerate decline in HIV incidence. b) HIV incidence decline were explained by increases in men’s access to HIV treatment, although barriers remain for young men. c) There is a high unmet sexual health need and self-testing, and self-sampling were popular. d) Targeted Pre-Exposure prophylaxis (PrEP) didn’t reach AGYW most at risk, whilst peer- navigators did. Specific aim 3: Ascertain whether family- and peer-network strategies improve uptake and adherence to combination prevention interventions by young people. We worked with youth to interrogate the findings and co-create an intervention. The result, Thetha Nami, (Talk to Me) consists of trained and supervised peer-navigators who provide health promotion to young people; youth-friendly clinical services; and peer-mentorship to improve retention in HIV prevention. We are currently testing the acceptability and feasibility of this approach on improving adolescents and youth uptake and retention of HIV care and prevention. Our multidisciplinary team includes HIV epidemiologists, a biostatistician, social scientists, psychologist, and intervention development expertise in South Africa. Moving forward, this will provide answers to: ‘Can peers and community-level interventions harness the full mortality and HIV incidence reducing potential of HIV prevention for adolescents and young people in rural SSA?’