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.

项目总结

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)