Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women

最大限度地提高青春期女孩和年轻女性的艾滋病毒预防、感染率和保留率

• 批准号: 10261448
• 负责人: Maryam Shahmanesh
• 金额: $ 28.83万
• 依托单位: KWAZULU-NATAL RESEARCH INSTITUTE TB-HIV
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-18 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10261448
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Adolescence; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Area; Attitude; Behavior Therapy; Biological Markers; Caring; Clinical; Communities; Contraceptive methods; Data; Epidemic; Epidemiologist; Event; Exposure to; Family; Female Adolescents; Financial cost; Gender; Goals; HIV; Health; Health care facility; Home; Household; Human immunodeficiency virus test; Hygiene; Incidence; Individual; Interdisciplinary Study; Intervention; Interview; Life Cycle Stages; Life Expectancy; Link; London; Male Circumcision; Medical; Mentors; Modeling; Outcome Measure; Paper; Population; Population Analysis; Population Surveillance; Prevention; Prevention program; Prevention therapy; Provider; Psychologist; Public Sector; Records; Research; Research Institute; Risk; Risk Behaviors; Rural; Schools; Science; Scientist; Sex Behavior; Site; South Africa; Survival Analysis; Testing; Time; Tropical Medicine; United States National Institutes of Health; Universities; Work; Youth; acceptability and feasibility; adaptive intervention; adolescent HIV prevention; antiretroviral therapy; college; condoms; empowered; family caregiving; family support; gender-based violence; high risk; improved; innovation; male; migration; mortality; multidisciplinary; novel; peer; peer networks; peer support; population health; pre-exposure prophylaxis; preventive intervention; programs; prospective; response; rural South Africa; rural setting; scale up; service uptake; social; social stigma; success; surveillance data; therapy design; therapy development; treatment program; uptake; young woman

Project Summary Our overarching goal is to arrest the HIV epidemic and its negative impact on young people in sub Saharan African (SSA) through improving the uptake, retention and adherence of multi-level combination HIV prevention by AGYW and male partners. South Africa has an estimated 6.3 million people living with HIV – the highest in the world. Despite having the largest HIV treatment program in the world, HIV incidence in Adolescent Girls and Young Women (AGYW aged 15-24) remains extremely high. Whilst there have been significant innovations in combination HIV prevention, e.g. universal test and treat (UTT) and Pre-exposure prophylaxis (PrEP), this has far outpaced the ability to deliver them. To control the HIV epidemic here is an urgent to significantly improve uptake and retention of HIV prevention by AGYW and male partners, alongside UTT of those testing positive. In this project we have a unique opportunity to leverage a key time-sensitive events in a poor and rural hyperendemic area of KwaZulu-Natal: The roll out of eight new youth-focused multi- level HIV prevention interventions for AGYW and their male partners by PEPFAR’s Determined, Resilient, Empowered, AIDS free, Mentored, and Safe (DREAMS) program in the context of a state of the art demographic and health surveillance, where data on individual HIV biomarkers, sexual behaviors, HIV prevention and ART exposure are linked to public-sector clinical records for HIV and other care. We will achieve this through three interlinked aims: Specific aim 1: Quantify how multiple levels of social dynamics interact to predict uptake of DREAMS components. Approach: We will use hierarchical analysis of population surveillance data to evaluate how community, household and interpersonal-level exposures predict uptake of each intervention, and two composite outcome measures: 1) Exposure to community-level DREAMS interventions, 2) uptake of the individual-level HIV care and prevention. Specific aim 2: Elucidate how individuals’ life-course transitions and exposure to DREAMS affect retention and adherence to HIV care and prevention. Approach: We will use both survival analysis of the population surveillance data and in-depth qualitative interviews to evaluate how specific life-course events affect HIV prevention and care cascade trajectories and how community-level DREAMS exposures moderate the impact of life-course transitions on adherence and retention. Specific aim 3: Ascertain whether family- and peer-network strategies improve uptake and adherence to combination prevention interventions by young people. Approach: we will work with youth to adapt existing models of community and peer-support to develop an intervention informed by aims 1 and 2. We will pilot the acceptability and feasibility of this approach on improving AGYW and male peers uptake and retention of HIV care and prevention. Our multidisciplinary team includes HIV epidemiologists, a biostatistician, social scientists, psychologist and intervention development expertise from the Africa Health Research Institute, University College London, Southampton and the London School of Hygiene and Tropical Medicine. Moving forward, this will provide answers to an NIH priority area: Can using peer, family and community-level networks harness the full mortality and HIV incidence reducing potential of multi-level HIV prevention for adolescents and young people in rural SSA?

项目摘要 我们的首要目标是遏制艾滋病毒流行及其对撒哈拉以南非洲青年的负面影响 非洲（撒哈拉以南非洲）通过改善艾滋病毒多层次组合的吸收、保留和坚持 青少年妇女协会和男性伙伴的预防。南非估计有630万艾滋病毒感染者， 世界上最高的。尽管拥有世界上最大的艾滋病毒治疗计划， 少女和青年妇女（15-24岁）的比例仍然极高。虽然有 联合预防艾滋病毒方面的重大创新，例如普遍检测和治疗（UTT）和暴露前 预防（PrEP），这远远超过了提供它们的能力。为了控制艾滋病的流行， 迫切需要大大提高青年女青年和男性伙伴对艾滋病毒预防的接受和保持， UTT检测呈阳性。在这个项目中，我们有一个独特的机会，利用一个关键的时间敏感 在夸祖鲁-纳塔尔的一个贫困和农村高流行地区的活动：推出八个新的以青年为重点的多 艾滋病防治紧急救援计划的“坚决、有弹性、 在最先进的背景下，实施授权、无艾滋病、辅导和安全（梦想）计划 人口和健康监测，其中有关个人艾滋病毒生物标志物，性行为，艾滋病毒 预防和抗逆转录病毒疗法接触与公共部门艾滋病毒和其他护理的临床记录有关。我们将 具体目标1：量化多层次社会动态如何 互动来预测DREAMS组件的摄取。方法：我们将使用人群分层分析 监测数据，以评估社区、家庭和人际接触如何预测 每个干预措施，和两个复合结果的措施：1）暴露于社区层面的梦想 2）采取个人层面的艾滋病毒护理和预防。具体目标2：阐明如何 个人的生命历程过渡和接触梦想影响保留和坚持艾滋病毒护理， 预防方法：我们将使用人群监测数据的生存分析和深入研究 定性访谈，以评估具体的生命过程事件如何影响艾滋病毒预防和护理级联 轨迹以及社区层面的梦想暴露如何缓和生命历程转变对 坚持和保留。具体目标3：确定家庭和同伴网络战略是否得到改善 青年人接受和坚持综合预防干预措施。方法：我们将与 青年调整现有的社区和同伴支持模式，以制定一项以目标1为依据的干预措施 和2.我们将试验这种方法在改善AGYW和男性同龄人方面的可接受性和可行性 接受和保持艾滋病毒护理和预防。我们的多学科团队包括艾滋病毒流行病学家， 来自非洲卫生组织的生物统计学家、社会科学家、心理学家和干预发展专家 南安普顿伦敦大学学院和伦敦卫生和热带学院研究所 药展望未来，这将为NIH的优先领域提供答案：可以使用同伴，家庭和 社区一级的网络利用多层次艾滋病毒的全部死亡率和艾滋病毒发病率降低潜力 在撒哈拉以南非洲的农村地区，青少年和年轻人的预防工作如何？