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.

摘要 减少南非少女和年轻妇女中新的艾滋病毒和性传播感染 (AGYW)是全球公共卫生优先事项。1 SA拥有世界上最大的艾滋病毒流行，2，3和SA AGYW收购 艾滋病毒感染率是男性的两倍，平均比男性早5-7年。 感染的速度继续超过获得和获得PrEP和ART的速度，初级预防仍然是 最可行的遏制新传播的战略。1，4，5南非努力预防艾滋病毒在青年中的传播 主要是个人层面的行为变化，6-8，但AGYW持续的艾滋病毒差异是由以下原因解释的 塑造和制约艾滋病毒危险行为的广泛的社会和结构性不平等。9-14全面艾滋病毒 综合、协同并针对当地流行病学和文化因素量身定做的一揽子预防措施 环境可能实现并维持艾滋病毒风险的最大降低。15-22名女性照顾者(FC)是 艾滋病毒预防工具箱23、24中未开发的资源，并提供了加强AGYW的新机会 预防工作。AGYW也可能是其FC的变革推动者，他们希望成为以下方面的积极榜样 因此，采取包括HTC和PrEP在内的艾滋病毒预防行为。在生态环境的指引下 框架，我们经验丰富的多学科团队将适应(阶段1/UG3)并评估 (2期/UH3期)Imara，一种多水平、创新、以家庭为基础的艾滋病毒的有效性和成本效益 针对个人、社会和结构性风险驱动因素的预防计划，以减少艾滋病毒和性传播感染 突发感染，减少危险的性行为，并增加HTC和PrEP的摄入量(在适当的情况下) 在AGYW和FC。Imara在12个月的随访中显示出事件STI减少了45% 美国14-18岁的黑人女孩，以及增加了FC的艾滋病毒检测。试点数据为71 AGYW和FC at 德斯蒙德·图图艾滋病毒基金会(DTHF；研究地点)确认了Imara用于 南非的背景。这项研究将纳入DTHF的青少年友好服务。 如果有效，西开普省都会区促进可持续发展。使用Adapt-ITT模型，我们将 系统地为SA环境量身定做Imara，然后对300名15-19岁的儿童进行双臂RCT AGYW和FC。FC和AGYW将完成基线、6个月和12个月的评估，包括测试 用于3个STI。我们将在每次评估中提供HTC和PrEP，并跟踪吸收情况和与CARE的联系。AGYW 性传播感染和/或艾滋病毒检测呈阳性的FC将在DTHF接受免费治疗。我们将收集数据以 确定伊马拉的成本。分析将比较AGYW和FC在干预和控制方面的差异 关于性风险、性传播感染和艾滋病毒发病率、PrEP和HTC摄取以及理论介体的计划。 这项研究回答了对联合的有效性和成本效益进行评估的迫切需要 为AGYW提供艾滋病毒预防套餐，以实现无艾滋病的一代。