A COGNITIVE BEHAVIORAL AND STRUCTURAL HIV PREVENTION INTERVENTION FOR YOUNG UGANDAN WOMEN ENGAGING IN HIGH RISK SEXUAL BEHAVIOR

 描述(申请人提供)：全球约有600万年轻人(15-24岁)感染艾滋病毒。15至24岁从事高危性行为的年轻女性是乌干达最危险的人群之一；这一群体的艾滋病毒流行率估计为26%，而全国的流行率为4.9%，乌干达的总生育率继续位居世界最高之列。未感染艾滋病毒的年轻妇女特别容易感染包括艾滋病毒和意外怀孕在内的性传播感染，因此特别需要有效的艾滋病毒预防、护理、支持和生殖健康服务。从事交易性工作的乌干达年轻妇女尤其容易受到伤害。这项研究旨在为乌干达坎帕拉15-24岁从事高危性行为的未感染艾滋病毒的年轻女性开发和测试结构和认知行为预防干预方案。预防干预将对这些高危女性采取三管齐下的方法，包括：1)包括替代生计选择和指导的同龄人小组会议，2)通过移动技术建立网络和加强健康行为，以及3)由值得信赖的成年人进行认知行为咨询。我们将对总共450名15-24岁未感染艾滋病毒的高危妇女进行分层随机对照试验，在乌干达坎帕拉现有的一家专门的社区诊所对其进行为期18个月的跟踪调查，该诊所为2300名15岁及以上的女性性工作者提供服务。这项研究的具体目的将是：1)开展形成性研究，探索乌干达坎帕拉年轻妇女(15-24岁)的社会和性网络、流动性和背景的动态；2)评估综合预防干预措施对无保护性行为频率的有效性；3)评估综合预防干预措施在减少未满足的计划生育需求和意外怀孕发生率方面的效果。妇女将被同意、登记和随机接受干预，包括4次互动小组会议和2次一对一咨询会议，或接受由卫生部培训的顾问指导的艾滋病毒和其他性传播感染的标准预防服务，包括分发避孕套。参与者将被跟踪观察18个月。这项研究将是向国家政策和指导方针宣传乌干达年轻高危妇女艾滋病毒护理和治疗的结构/认知行为、对青年友好的方法的影响的重要的第一步。

 DESCRIPTION (provided by applicant): There are about six million young people (15-24 years) with HIV globally. Young women age 15 to 24 years who engage in high risk (YWHR) sexual activity are one of the most-at-risk populations in Uganda; HIV prevalence among this group has been estimated at 26% compared to national prevalence of 4.9%, and Uganda's total fertility rate continues to rank among the highest in the world. Young HIV-uninfected women are especially vulnerable to sexually transmitted infections (STI) including HIV and unplanned pregnancies and thus are in particular need of effective HIV prevention, care, support, and reproductive health services. Young Ugandan women who engage in transactional sex work, are particularly vulnerable. This study aims to develop and test a structural and cognitive behavioral prevention intervention package for HIV-uninfected young women aged 15-24 engaging in high risk sexual behavior in Kampala, Uganda. The prevention intervention will use a three-prong approach for these high-risk women consisting in: 1) peer group sessions that include alternative livelihood options and mentoring, 2) networking and healthy behavior reinforcement through mobile technology, and 3) cognitive behavioral counselling by a trusted adult. We will conduct a stratified randomized controlled trial among a total of 450 HIV-uninfected high risk women 15-24 years old followed for 18 months in an existing specialized community-based clinic in Kampala, Uganda providing services to 2300 female sex workers aged 15 and older. The specific aims of the study will be: 1) To conduct formative research exploring the dynamics of the social and sexual networks, mobility and context of young women (aged 15-24) in Kampala, Uganda; 2) To assess the effectiveness of a combination prevention intervention on the frequency of unprotected sex and 3) To assess the effect of combination prevention intervention on reducing the unmet need for family planning (FP) and the incidence of unintended pregnancies. Women will be consented, enrolled and randomized to receive either the intervention including 4 interactive group sessions and two one-on-one counselling sessions or standard prevention services for HIV and other STI guided by Ministry of Health trained counsellors including condom distribution. Participants will be followed for 18 months. This study will be an important first step towards informing national policy and guidelines about the effect of a structural/cognitive behavioral, youth-friendly approach to HIV care and treatment for young high risk women in Uganda.