Shikamana PrEP: A Community Participatory Approach to Integrating PrEP, Sexual Health, and Mental Health Services for GBMSM in Kenya

Shikamana PrEP：肯尼亚 GBMSM 整合 PrEP、性健康和心理健康服务的社区参与方法

• 批准号: 10064644
• 负责人: Susan Marie Graham
• 金额: $ 20.22万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064644
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adoption; Africa; African; Age-Years; Anti-Retroviral Agents; Area; Awareness; Behavior Therapy; Behavioral; Behavioral Sciences; Bisexual; Caring; Case Management; Centers for Disease Control and Prevention (U.S.); Charge; Cities; Clinic; Clinical Trials; Cohort Studies; Collaborations; Communities; Continuity of Patient Care; Counseling; Decision Making; Discrimination; Enrollment; Ensure; Epidemiologist; Feedback; Female; Fostering; Gays; General Population; HIV; HIV Seronegativity; HIV Seropositivity; HIV risk; HIV-1; Health Personnel; Health Promotion; Health protection; Homophobia; Human immunodeficiency virus test; Information Services; Infrastructure; Intervention; Kenya; Leadership; Lesbian Gay Bisexual Transgender Intersex; Mental Health; Mental Health Services; Michigan; Modeling; Outcome; Pharmaceutical Preparations; Plasma; Population; Prevalence; Production; Provider; Public Health; Randomized Controlled Trials; Recommendation; Recording of previous events; Reporting; Reproductive Health; Research; Resources; Rights; Risk; Risk Reduction; Safety; Scientist; Sexual Health; Societies; Testing; Training; United States National Institutes of Health; Universities; Viral; Viral Load result; Vulnerable Populations; Washington; Work; World Health Organization; acceptability and feasibility; antiretroviral therapy; base; cohort; design; early experience; experience; follow-up; high risk men; marginalized population; men; men who have sex with men; motivational enhancement therapy; multi-component intervention; multidisciplinary; peer; peer support; pre-exposure prophylaxis; prevention service; programs; prospective; resilience; scale up; sex; sexual health intervention; social stigma; standard of care; success; theories; therapy adherence; therapy design; uptake; virology

Project Summary Gay, bisexual, and other men who have sex with men (GBMSM) are at high risk for HIV-1 acquisition, especially in rights-constrained settings such as Kenya, where men's access to HIV prevention has been impeded by homophobia, stigma, and discrimination. Pre-exposure prophylaxis (PrEP) has the potential to greatly reduce HIV acquisition risk in this key population, if accessible, sustainable PrEP programming with tailored, effective adherence support can be provided. To this end, close collaboration between PrEP program implementers and GBMSM-led community-based organizations is essential. In this R34 application, we propose (1) to identify multi-level barriers and facilitators that influence GBMSM's ability to engage in the PrEP continuum of care by examining socioecological factors that impact Kenyan GBMSM's lives, including sexual and PrEP-related stigma, sexual health promotion, and resilience, through qualitative work with PrEP- experienced and PrEP-naïve GBMSM and peers engaged in HIV testing/counseling or PrEP programming; (2) to adapt and enhance a theory-based and culturally relevant PrEP support intervention called Shikamana PrEP that includes peer navigation and integrated “Next Step Counseling” to promote sexual health protection strategies, including PrEP uptake and adherence, among GBMSM in Kisumu, following steps 1-6 of the ADAPT-ITT model (assessment, decision-making, adaptation, production, expert review, and integration of feedback) in collaboration with our GBMSM community partners; and (3) to determine the acceptability, feasibility, and safety of the Shikamana PrEP intervention and estimate initial effect size compared to standard of care on PrEP uptake and adherence assessed by drug levels over 6 months in a pilot randomized controlled trial. This proposal builds on the success of the Shikamana study, which developed a provider and peer support intervention that successfully increased the odds of plasma viral load suppression among HIV-positive GBMSM taking antiretroviral therapy, and the Anza Mapema project, which enrolled over 600 HIV-negative GBMSM in Kisumu for 12 months of follow-up in HIV prevention services and is currently following a PrEP cohort of 167 men for 12 months. Our experienced, productive multidisciplinary team of collaborators from the University of Washington, University of Michigan, and the Nyanza Reproductive Health Society, has expertise in the fields of HIV prevention and care (Drs. Graham, Otieno, and Bailey) and behavioral science and intervention design (Drs. Graham, Harper, Amico, and Simoni), and has partnered for this research with the NYARWEK Network of 23 community-based LGBTI organizations in the study area. We anticipate that results of the proposed research will have high impact by ensuring GBMSM involvement in the scale-up of effective PrEP programming for this key population in Kenya and providing a peer-led PrEP support model for GBMSM and other vulnerable and marginalized populations in African settings.

项目摘要 男同性恋、双性恋和其他男男性行为者（GBMSM）感染HIV-1的风险很高， 特别是在权利受到限制的环境中，如肯尼亚，在那里，男子获得艾滋病毒预防的机会一直受到限制， 受到同性恋恐惧症、污名化和歧视的阻碍。暴露前预防（PrEP）有可能 大大降低这一关键人群的艾滋病毒感染风险，如果可以获得，可持续的PrEP方案， 可以提供定制的、有效的粘附支持。为此，PrEP计划之间的密切合作 实施者和GMBMSM领导的社区组织的参与至关重要。在这个R34应用程序中，我们 建议（1）确定影响GBMSM参与PrEP能力的多层次障碍和促进因素 通过检查影响肯尼亚GBMSM生活的社会生态因素，包括性行为， 和PrEP相关的耻辱，性健康促进，和弹性，通过定性工作与PrEP- 经验丰富和PrEP初治GBMSM和同行从事艾滋病毒检测/咨询或PrEP编程;（2） 调整和加强基于理论和文化相关的PrEP支持干预，称为Shikamana PrEP包括同伴导航和综合“下一步咨询”，以促进性健康保护 在基苏穆的GBMSM中，按照第1-6步， ADAPT-ITT模型（评估、决策、调整、制作、专家评审和 反馈）与我们的GBMSM社区合作伙伴合作;以及（3）确定可接受性， Shikamana PrEP干预的可行性和安全性，以及与标准相比的估计初始效应量 在一项试验性随机对照研究中，通过6个月内的药物水平评估PrEP吸收和依从性的护理 审判这项建议建立在Shikamana研究的成功基础上， 支持干预措施，成功地增加了艾滋病毒阳性患者血浆病毒载量抑制的几率 接受抗逆转录病毒治疗的GBMSM，以及Anza Mapema项目，该项目招募了600多名艾滋病毒阴性者， 基苏穆的GBMSM在艾滋病毒预防服务中进行了12个月的随访，目前正在进行PrEP 167名男性队列研究12个月。我们经验丰富、富有成效的多学科合作团队来自 华盛顿大学、密歇根大学和尼扬扎生殖健康协会都有专业知识 在艾滋病毒预防和护理（格雷厄姆博士，Otieno和贝利）和行为科学领域， 干预设计（格雷厄姆博士，哈珀，阿米科，和西蒙尼），并已合作进行这项研究与 NYARWEK网络的23个社区为基础的LGBTI组织在研究领域。我们预计， 拟议的研究将通过确保GBMSM参与扩大有效的 为肯尼亚的这一关键人群制定PrEP方案，并为GBMSM提供同行领导的PrEP支持模式 以及非洲环境中其他弱势和边缘化群体。

项目成果

"God Didn't Make a Mistake in Creating Me": Intrapersonal Resilience Processes among Gay and Bisexual Male Youth in Kenya.

• DOI: 10.3390/adolescents1030020
• 发表时间: 2021-09
• 期刊: Adolescents (Basel, Switzerland)