Understanding and measuring the impact of stigma on PrEP adherence among adolescent girls and young women in Kenya: identifying targets for future interventions

项目摘要/摘要 撒哈拉以南非洲的少女和年轻妇女极易感染艾滋病毒。在肯尼亚， 15-24岁的年轻人占每年新感染人数的33%，青年队的发病率是青年队的两倍 是在年轻人身上。暴露前预防(PrEP)是减少艾滋病毒感染的有力工具，但 AGYW的依从性一直较低，限制了其保护作用。PREP耻辱--通常基于 对吸毒者“滥交”或艾滋病毒阳性的刻板印象正在成为坚持使用的一个关键障碍。然而， AGYW中的证据有限。拟议研究的目标是提高我们对耻辱的理解-- 肯尼亚AGYW遵守PrEP的相关障碍，并确定潜在的干预方法 和目标。这项研究将建立在我们最近的研究基础上，以适应健康污名和歧视 在AGYW中消除PrEP污名的框架，并将利用我们与Impact的成功伙伴关系 研究和发展组织(IRDO)，该组织正在Siaya实施DREAMS倡议 在肯尼亚的一个县，已经发起了3,900多个AGYW关于PrEP。我们将在以下方面建立污名研究能力 通过指导职业早期研究人员和培训当地AGYW青年研究人员，实现了国际青年研究组织的目标。这个 具体目标是：(1)开发和验证用于测量PrEP相关维度的定标仪器 使用PrEP的AGYW中的耻辱，以及(2)评估耻辱和PrEP依从性之间的关系 并确定干预目标。目标1将使用青年主导的参与性研究来改善PrEP污名 与AGYW的框架，确定PrEP耻辱的关键组成部分，并了解相关类型的 耻辱(艾滋病毒、性别和性取向)与PrEP耻辱重叠。调查结果将为未来的发展提供信息 初始比例。经过认知测试后，该量表将与200个AGYW一起试行，以验证假设 因素结构并评估信度和结构效度，包括它是否有别于其他类型的 耻辱。AIM 2将使用混合方法方法。对于Aim 2a，我们将对300人进行定量调查 AGYW PrEP用户，以确定影响AGYW的各种类型和规模的污名的流行率， 用Aim 1标尺测量PrEP的污点。参与者将使用梦境进行前瞻性跟踪 程序数据，以测试基线污名与PrEP依从性的关联(持久性和 执行)在接下来的6个月里。对于目标2b，我们将进行定性的焦点小组讨论， AGYW及其主要影响者(家庭成员、同伴、合作伙伴和医疗保健提供者)以了解 污名化态度和行为，评估候选干预措施的可接受性。定性的 并将整合量化结果，以确定未来的干预目标和方法。这项研究是 关注肯尼亚AGYW中的PrEP污名是创新的，填补了结束艾滋病毒努力的一个关键空白 流行病。这些发现将为开发和测试一种文化定制的、适合年龄的 减少耻辱干预，旨在提高这一弱势群体对PrEP的依从性。

PROJECT SUMMARY/ABSTRACT Adolescent girls and young women (AGYW) in sub-Saharan Africa are highly vulnerable to HIV. In Kenya, youth ages 15–24 account for 33% of new infections annually, and incidence is twice as high in AGYW as it is in young men. Pre-exposure prophylaxis (PrEP) is a powerful tool to reduce HIV acquisition, but adherence has been low among AGYW, limiting its protective benefit. PrEP stigma—typically based on stereotypes of users as “promiscuous” or HIV-positive—is emerging as a key barrier to adherence. However, evidence among AGYW is limited. The goal of the proposed study is to improve our understanding of stigma- related barriers to PrEP adherence among AGYW in Kenya and identify potential intervention approaches and targets. The study will build on our recent research to adapt the Health Stigma and Discrimination Framework for PrEP stigma among AGYW and will leverage our successful partnership with Impact Research and Development Organization (IRDO), which is implementing the DREAMS Initiative in Siaya County, Kenya and has initiated more than 3,900 AGYW on PrEP. We will build stigma research capacity at IRDO by mentoring early-career Research Associates and training local AGYW youth researchers. The specific aims are to (1) develop and validate a scaled instrument to measure relevant dimensions of PrEP stigma among AGYW who use PrEP, and (2) assess the relationship between stigma and PrEP adherence and identify intervention targets. Aim 1 will use youth-led participatory research to refine the PrEP stigma framework with AGYW, identify key components of PrEP stigma, and understand how related types of stigma (HIV, gender, and sexuality) overlap with PrEP stigma. Findings will inform the development of the initial scale. After cognitive testing, the scale will be piloted with 200 AGYW to confirm the hypothesized factor structure and assess reliability and construct validity, including whether it is distinct from other types of stigma. Aim 2 will use a mixed methods approach. For Aim 2a, we will conduct a quantitative survey with 300 AGYW PrEP users to determine the prevalence of various types and dimensions of stigma impacting AGYW, measuring PrEP stigma with the Aim 1 scale. Participants will be prospectively followed using DREAMS program data to test the association of baseline stigma with PrEP adherence (both persistence and execution) over the next 6 months. For Aim 2b, we will conduct qualitative focus group discussions with AGYW and their key influencers (family members, peers, partners, and health care providers) to understand stigmatizing attitudes and behaviors and assess the acceptability of candidate interventions. The qualitative and quantitative findings will be integrated to identify future intervention targets and approaches. This study’s focus on PrEP stigma among Kenyan AGYW is innovative and fills a critical gap in efforts to end the HIV epidemic. The findings will lay the groundwork to develop and test a culturally tailored, age-appropriate stigma reduction intervention, which will aim to increase PrEP adherence in this vulnerable population.