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Multilevel Comprehensive HIV Prevention for South African Adolescent Girls and Young Women

南非少女和年轻妇女的多层次综合艾滋病毒预防

基本信息

批准号：
10252938
负责人：
GERI R DONENBERG
金额：
$ 87.92万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10252938
关键词：
18 year old 19 year old AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adolescent Adopted Africa Africa South of the Sahara Alcohol consumption Area Behavior Biomedical Technology Caregivers Caring Continuity of Patient Care Cost Control Counseling Data Decision Making Discrimination Drug usage Economics Educational Curriculum Effectiveness Epidemic Epidemiology Evaluation Evidence based intervention Failure Family Female Female Adolescents Foundations Generations Goals Government HIV HIV Infections HIV risk HIV/STD Health Health Promotion Human immunodeficiency virus test Incidence Individual Infection Intervention Mediator of activation protein Mental disorders Methodology Modeling Outcome Phase Pilot Projects Politics Prevalence Prevention Prevention program Primary Prevention Process Public Health Reporting Research Resources Risk Risk Behaviors Safe Sex Science Services Sex Behavior Shapes Site South Africa South African Testing Time Woman Youth acceptability and feasibility age group arm base behavior change compare effectiveness condoms cost cost effectiveness cost-effectiveness evaluation data sharing design effectiveness evaluation experience follow-up girls high risk sexual behavior improved innovation male men metropolitan mortality multidisciplinary novel peer phase II trial pre-exposure prophylaxis prevent programs public health priorities role model sexual risk behavior sexual risk taking social culture social stigma social structure stem transmission process uptake young woman

项目摘要

ABSTRACT Reducing new HIV and STI infections among South African (SA) adolescent girls and young women (AGYW) is global public health priority.1 SA has world's largest HIV epidemic,2,3 and SA AGYW acquire HIV at twice the rate of and seroconvert on average 5 – 7 years earlier than male peers.3 As new infections continue to outpace access to and availability of PrEP and ART, primary prevention remains the most viable strategy to stem new transmissions.1,4,5 SA efforts to prevent HIV transmission in youth focus mostly on individual-level behavior change,6-8 but AGYW's persistent HIV disparities are explained by broad social and structural inequities that shape and constrain HIV-risk behaviors.9-14 Comprehensive HIV prevention packages that are integrated, synergistic, and tailored to the local epidemiology and cultural context are likely to achieve and sustain maximum reductions in HIV-risk.15-22 Female caregivers (FC) are an untapped resource in the HIV prevention toolbox23,24 and offer a novel opportunity to strengthen AGYW prevention efforts. AGYW may also be change agents for their FC who want to be positive role models for AGYW, and thus, adopt HIV prevention behaviors, including HTC and PrEP. Guided by an ecological framework, our highly experienced multidisciplinary team will adapt (phase 1/UG3) and evaluate the effectiveness and cost-effectiveness of (phase 2/UH3) IMARA, a multilevel, innovative, family-based HIV prevention program that targets individual, social, and structural drivers of risk to decrease HIV and STI incident infections, reduce risky sexual behavior, and increase HTC and PrEP uptake (where appropriate) in AGYW and FC. IMARA demonstrated a 45% reduction in incident STI at 12-month follow-up among black 14-18 year-old girls in the US, and increased HIV testing in FC. Pilot data with 71 AGYW and FC at the Desmond Tutu HIV Foundation (DTHF; study site) confirm feasibility and acceptability of IMARA for the South African context. This study will be integrated into the adolescent-friendly services at DTHF in the Western Cape metropolitan area facilitating sustainability if effective. Using the ADAPT-ITT model, we will systematically tailor IMARA for the SA context and then conduct a 2-arm RCT with 300 15-19 year-old AGYW and FC. FC and AGYW will complete baseline, 6-, and 12-month assessments, including testing for 3 STI. We will offer HTC and PrEP at each assessment and track uptake and linkage to care. AGYW and FC who test positive for a STI and/or HIV will receive free treatment at DTHF. We will collect data to determine the costs of IMARA. Analyses will compare AGYW and FC across the intervention and control programs on sexual risk taking, STI and HIV incidence, PrEP and HTC uptake, and theoretical mediators. The study answers an urgent need to evaluate the effectiveness and cost-effectiveness of combination HIV prevention packages for AGYW to achieve an AIDS-free generation.

摘要