Making women's options for HIV prevention in Tanzania accessible and joining implementation science capacity building (MWOTAJI)

总结 撒哈拉以南非洲的少女和年轻妇女（15-24岁）面临着不成比例的负担 艾滋病毒感染。尽管像暴露前预防（PrEP）这样的高效艾滋病毒预防是预防艾滋病的核心， 艾滋病毒流行病控制全球战略，青年男女青年对PrEP的认识很低， 即使是较低级的卫生系统也往往装备不足，无法克服众多的准入障碍。 青年和女青年协会面临的各种挑战，包括耻辱、有害的规范和诊所保健服务的不便。 人们越来越认识到，社区药店有可能弥补艾滋病毒方面的差距 预防和减少青年女青年之间的准入障碍。因此，本研究的目的是评估Malkia Klabu（“女王俱乐部”）在坦桑尼亚的实施战略，这是一个由AGYW设计并为之设计的忠诚度计划， 创建青年友好型药房，青年志愿者协会可在这些药房获得艾滋病毒预防以及性和生殖服务。 健康（SRH）服务，与基于设施的护理密切相关。 基于我们的试点研究的有希望的数据，我们假设， 通过Malkia Klabu实施模式的药房环境将吸引AGYW并加强吸收 预防性教育、艾滋病毒自我检测和其他性健康和生殖健康服务，从而使青年妇女协会有能力避免艾滋病毒， 意外怀孕我们设计了一项创新的、为期5年的实施科学研究， 评估Malkia Klabu基于药物的PrEP和HIVST交付方法的几种模型， 研究地点在坦桑尼亚湖区使用RE-AIM框架。这项研究将得到加强， 对当地研究人员和政策制定者进行实施科学培训，以优化Malkia Klabu， 未来的艾滋病毒预防战略。我们将首先进行第3类混合实施效果研究， Malkia Klabu在50家药店的四种基于药店的差异化PrEP交付模式， 在增加用户分摊费用之前和之后的执行结果， 可持续性（目标1）。我们将研究Malkia Klabu交付模式在有效使用 PrEP在575名AGYW人群中的应用，该计划在一项横断面家庭调查中的覆盖率为750 研究领域的AGYW;约200 AGYW的药房退出调查将有助于描述药房的成功- 基于PrEP的服务提供（目标2）。实施科学证书加上种子赠款， 毕业生将确保该项目产生持久影响（目标3）。 在研究结束时，我们将确定最强大和最可持续的Malkia Klabu版本 向AGYW提供基于药物的PrEP和HIVST的实施战略，并启动了 实施科学培训方案，使地方主导的扩大和适应工作能够惠及弱势群体 在坦桑尼亚和该地区的青年协会。该项目是Mzumbe大学，卫生和 一个繁荣的国家，坦桑尼亚卫生部和加州大学（旧金山弗朗西斯科和伯克利）。

SUMMARY Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face a disproportionate burden of HIV infection. Though highly effective HIV prevention like pre-exposure prophylaxis (PrEP) is central to the global strategy for HIV epidemic control, awareness of PrEP among AGYW is low, with uptake and continuation even lower—health systems are often ill equipped to overcome the numerous access barriers faced by AGYW, including stigma, harmful norms, and the inconveniences of clinic-based health services. There is growing recognition that community-based pharmacies have the potential to bridge gaps in HIV prevention and mitigate access barriers among AGYW. Thus, the goal of this study is to evaluate the Malkia Klabu (“Queen Club”) implementation strategy in Tanzania, a loyalty program designed for and by AGYW that creates youth-friendly pharmacies where AGYW can access HIV prevention and sexual and reproductive health (SRH) services, with strong linkages to facility-based care. Based on promising data from our pilot study, we hypothesize that the creation of a welcoming and safe pharmacy environment through the Malkia Klabu implementation model will attract AGYW and bolster uptake of PrEP, HIV self-testing (HIVST), and other SRH services, thereby empowering AGYW to avoid HIV and unintended pregnancy. We have designed an innovative, 5-year implementation science study to scale and evaluate several models of Malkia Klabu’s pharmacy-based approach for PrEP and HIVST delivery in five research sites in Lake Zone, Tanzania using the RE-AIM framework. This research will be enhanced by implementation science training of local researchers and policymakers to optimize Malkia Klabu and benefit future HIV prevention strategies. We will first conduct a Type 3 Hybrid Implementation-Effectiveness study of four pharmacy-based differentiated PrEP delivery models of Malkia Klabu in 50 pharmacies, examining implementation outcomes before and after the addition of user cost-sharing which is essential for real-world sustainability (Aim 1). We will examine the success of the Malkia Klabu delivery models on effective use of PrEP among a cohort of 575 AGYW, reach of the program in a cross-sectional household survey with 750 AGYW in study areas; pharmacy exit surveys with ~200 AGYW will help describe the success of pharmacy- based PrEP service offerings (Aim 2). A Certificate in Implementation Science coupled with seed grants for graduates will ensure the project has lasting impact (Aim 3). At the study’s conclusion, we will determine the strongest and most sustainable version of the Malkia Klabu implementation strategy for pharmacy-based PrEP and HIVST delivery to AGYW, and launched an implementation science training program to enable locally-led scaling and adaptation to reach vulnerable AGYW across Tanzania and the Region. The project is a collaboration between Mzumbe University, Health for a Prosperous Nation, the Tanzania Ministry of Health, and University of California (San Francisco & Berkeley).