Understanding HIV risk and service use in hotspot Ugandan fishing communities

描述：在乌干达Rakai地区，维多利亚湖的渔业社区有极高的艾滋病毒流行率（35-48%）和发病率（~3.9/100人年）。这些地理热点加剧了艾滋病毒的流行，但尚未成为艾滋病毒预防和产生需求的联合努力的重点。我们提出了一项顺序混合方法研究，以了解影响Rakai三个渔业社区艾滋病毒风险和服务利用的因素，并通过数据三角测量和社区反馈迭代开发一个集成的，量身定制的CHP和需求生成计划。这项研究将通过Rakai健康科学计划（RHSP）进行，该计划负责监督该地区由pepfar资助的艾滋病毒服务，并在54个社区（包括三个渔业社区）的所有15-49岁居民中进行纵向队列研究。目标1将定性地评估3个渔业社区形成艾滋病毒风险的社会、职业和性别背景，包括性伙伴关系的性质和接受卫生防护中心服务的障碍。目标2将利用目标1的结果为渔业社区（N~2500）开发额外的调查模块，作为年度队列调查的一部分，定量评估与(1)艾滋病毒流行率和(2)各种艾滋病毒预防和护理服务的利用相关的关键因素的流行率和分布。目标3将根据目标1和目标2的结果，结合现有数据源（纵向监测数据、地理空间分析和临床服务提供统计）进行三角测量，为渔业社区制定量身定制的综合热电联产和需求生成计划，并进行第二轮定性研究，以促进社区对拟议干预措施的接受和反馈。然后将制定一个最终的社区支持和量身定制的卫生保健方法，以便在未来的研究中实施和评估。这将为东非及其他地区其他热点渔业社区的热电联产和需求产生项目提供信息。

DESCRIPTION: In Rakai District, Uganda, fishing communities on Lake Victoria have extremely high HIV prevalence (35-48%) and incidence (~3.9/100 person-years). Such geographic hotspots fuel HIV epidemics, yet have not been the focus of combination HIV prevention (CHP) and demand generation efforts. We propose a sequential mixed methods study to understand the factors shaping HIV risk and service utilization in three Rakai fishing communities and iteratively develop an integrated, tailored CHP and demand generation program through data triangulation and community feedback. This study will be conducted through the Rakai Health Sciences Program (RHSP), which oversees PEPFAR-funded HIV services in the district and conducts a longitudinal cohort study among all residents aged 15-49 in 54 communities, including the three fishing communities. Aim 1 will qualitatively assess the social, occupational, and gendered context shaping HIV risk including nature of sexual partnerships and barriers to uptake of CHP services, in 3 fishing communities. Aim 2 will use findings from Aim 1 to develop additional survey modules for fishing communities (N~2500), as part of the annual cohort survey, to quantitatively assess the prevalence and distributions of key factors associated with (1) HIV prevalence, and (2) utilization of various HIV prevention and care services. Aim 3 will develop a tailored, integrated CHP and demand generation program for fishing communities based on findings from Aims 1 and 2, along with triangulation with existing data sources (longitudinal surveillance data, geospatial analytics, and clinical service delivery statistics), and a second round of qualitative research for community buy-in and feedback on the proposed interventions. A final community-supported and tailored CHP approach will then be developed to be implemented and evaluated in future studies. This will inform CHP and demand generation programs in other hotspot fishing communities in East Africa and beyond.