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

 描述（由申请人提供）：全球约有600万年轻人（15-24岁）感染艾滋病毒。从事高风险性活动的15至24岁的年轻妇女是乌干达风险最高的人群之一;据估计，这一群体的艾滋病毒流行率为26%，而全国流行率为4.9%，乌干达的总生育率仍然是世界上最高的。未感染艾滋病毒的年轻妇女特别容易受到性传播感染，包括艾滋病毒和意外怀孕，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。从事性交易工作的乌干达年轻妇女特别容易受到伤害。本研究旨在为乌干达坎帕拉从事高危性行为的15-24岁未感染艾滋病毒的年轻女性开发和测试一套结构和认知行为预防干预措施。预防干预将对这些高危妇女采用三管齐下的方法，包括：1）同龄人小组会议，包括替代生计选择和指导，2）通过移动的技术建立网络和加强健康行为，3）由可信赖的成年人提供认知行为咨询。我们将在乌干达坎帕拉一家现有的专业社区诊所对450名未感染艾滋病毒的15-24岁高危女性进行分层随机对照试验，随访18个月，该诊所为2300名15岁及以上的女性性工作者提供服务。研究的具体目标是：1）进行形成性研究，探索青年妇女的社会和性网络、流动性和背景的动态（15-24岁），乌干达坎帕拉; 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对减少未满足的计划生育需求和意外怀孕发生率的影响。妇女将获得同意、登记并随机接受干预，包括4次互动小组会议和两次一对一咨询会议，或接受由卫生部培训的咨询人员指导的艾滋病毒和其他性传播感染标准预防服务，包括分发避孕套。参与者将被跟踪18个月。这项研究将是向国家政策和指导方针提供信息的重要的第一步，这些政策和指导方针涉及结构/认知行为、对青年友好的艾滋病毒护理和治疗方法对乌干达年轻高危妇女的影响。

 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.