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

• 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
• 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

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.

抽象的 减少南非 (SA) 少女和年轻女性中新的艾滋病毒和性传播感染感染 (AGYW) 是全球公共卫生优先事项。1 南非拥有世界上最严重的艾滋病毒疫情，2,3 和南非 AGYW 收购 艾滋病毒感染率是男性同龄人的两倍，血清转化时间平均比男性同龄人早 5 – 7 年。3 感染继续超过 PrEP 和 ART 的获取和可用性，初级预防仍然是 阻止新的传播的最可行的策略。1,4,5 SA 努力以青年为重点预防艾滋病毒传播 主要是个人层面的行为变化，6-8 但 AGYW 持续存在的艾滋病毒差异可以解释为 广泛的社会和结构不平等塑造和限制了艾滋病毒风险行为。9-14 综合艾滋病毒 综合、协同、适合当地流行病学和文化的预防方案 环境可能会实现并维持艾滋病毒风险的最大程度降低。15-22 女性护理人员 (FC) HIV 预防工具箱中未开发的资源23,24 并为加强 AGYW 提供了新的机会 预防工作。 AGYW 也可能是其 FC 的变革推动者，他们希望成为 FC 的积极榜样 AGYW 因此采取 HIV 预防行为，包括 HTC 和 PrEP。以生态为导向 框架，我们经验丰富的多学科团队将适应（第 1 阶段/UG3）并评估 IMARA（2 期/UH3 期）的有效性和成本效益，IMARA 是一种多层次、创新、基于家庭的 HIV 针对个人、社会和结构风险驱动因素的预防计划，以减少艾滋病毒和性传播感染 事件感染，减少危险性行为，并增加 HTC 和 PrEP 的吸收（如适用） 在AGYW和FC。 IMARA 证明，在 12 个月的随访中，性传播感染事件减少了 45% 美国 14-18 岁的黑人女孩，以及FC 增加了艾滋病毒检测。 71 AGYW 和 FC 的飞行员数据位于 Desmond Tutu HIV 基金会（DTHF；研究中心）确认 IMARA 的可行性和可接受性 南非的背景。这项研究将被纳入 DTHF 的青少年友好服务中 如果有效，西开普都市区将促进可持续发展。使用 ADAPT-ITT 模型，我们将 针对 SA 背景系统地定制 IMARA，然后对 300 名 15-19 岁儿童进行 2 组 RCT AGYW 和 FC。 FC 和 AGYW 将完成基线、6 个月和 12 个月评估，包括测试 3 次性传播感染。我们将在每次评估时提供 HTC 和 PrEP，并跟踪使用情况以及与护理的联系。 AGYW STI 和/或 HIV 检测呈阳性的 FC 和 FC 将在 DTHF 接受免费治疗。我们将收集数据以 确定 IMARA 的成本。分析将比较 AGYW 和 FC 的干预和控制 关于性冒险、性传播感染和艾滋病毒发病率、PrEP 和 HTC 吸收以及理论中介的计划。 该研究满足了评估组合的有效性和成本效益的迫切需要 AGYW 的艾滋病毒预防方案，以实现无艾滋病一代。