Rakai Adolescent Project (RAP)

描述（由申请人提供）：通过政治承诺和社区动员，乌干达在控制艾滋病毒流行方面取得了显着进展，采用了各种预防方法，包括减少伴侣，促进ABC（禁欲，忠诚，使用避孕套）以及对艾滋病毒的开放。然而，年轻人艾滋病毒发病率稳定（每年1 - 3%），艾滋病毒危险行为增加，以及对预防疲劳和行为抑制的新担忧，削弱了乌干达预防成功所产生的乐观情绪。Rakai青年项目采用创新的定量和定性方法相结合的方法，并采用艾滋病毒传播的综合理论框架，将首先探讨15 - 24岁青年中艾滋病毒发病率的变化模式，并将评估社会和发展风险因素对新的艾滋病毒感染的长期影响。现有的Rakai社区队列研究提供了一个独特的机会，探讨青年感染艾滋病毒的风险因素，提供了一个纵向数据集，其中包括18年（1994 - 2012年）的各种潜在艾滋病毒决定因素。这些因素包括社会背景、个人心理社会和社会发展因素、性行为和生物因素。我们将根据婚姻状况和伴侣的年龄、入学率和成绩以及怀孕意图和愿望来比较艾滋病毒风险的具体情况。此外，伞Rakai健康科学计划有一个完善的定性研究部门，允许探索社会和发展因素与艾滋病毒感染之间的细微差别-包括艾滋病毒预防计划的影响，青少年生活目标和机会，同伴压力，关系动态和其他社会影响-这是很难在定量问卷中完全捕获的。第二个项目的目标是探讨艾滋病毒政策和方案在影响Rakai区青年艾滋病毒发病率方面的具体作用。RYP将探讨乌干达艾滋病毒预防和护理计划的四个关键“代”中艾滋病毒风险的变化：“零放牧”时代，向ABC和禁欲教育的转变，抗逆转录病毒（ARV）治疗后的一代，以及男性包皮环切术（MC）出现后成年的年轻人。抗逆转录病毒药物和MC的新可用性引起了对青年人行为抑制解除的相当大的关注。来自乌干达和美国的同事将共同努力，对这些发现进行综合和三角分析。根据研究结果，RYP将为乌干达Rakai和其他地方有艾滋病毒感染风险的青年制定结构层面和教育干预措施的建议。相关的研究传播活动将在战略上针对社区，国家和国际层面的关键政策和项目领导人。 公共卫生相关性：拟议的Rakai青年项目将探讨15 - 24岁青年艾滋病毒发病率的变化模式，并将评估社会和发展风险因素对新感染艾滋病毒的长期影响。我们将利用新的定性数据收集和现有的Rakai社区队列研究，探讨1994 - 2012年期间青年感染艾滋病毒的风险因素的变化。RYP还将探讨艾滋病毒政策和方案在影响Rakai地区青年艾滋病毒发病率方面的具体作用，并为青年艾滋病毒预防的结构层面和教育干预措施提出建议。

DESCRIPTION (provided by applicant): Through political commitment and community mobilization, Uganda has made notable progress in containing HIV prevalence using a variety of prevention approaches including partner reduction, promotion of ABC (Abstinence, Be Faithful, Use Condoms), and openness regarding HIV. However, stable HIV incidence among young people (1-3% per year), increases in HIV risk behaviors, and new concerns about prevention fatigue and behavioral disinhibition have tempered optimism generated by Uganda's prevention successes. Using an innovative combination of quantitative and qualitative methods, as well as a comprehensive theoretical framework for HIV transmission, the Rakai Youth Project (RYP) would first explore the changing patterns of HIV incidence among youth 15-24 years and would assess the influence of social and developmental risk factors for new HIV infections over time. The existing Rakai Community Cohort Study (RCCS) offers a unique opportunity to explore risk factors for HIV infection among youth, providing a longitudinal dataset with a broad array of potential HIV determinants, over 18 years (1994-2012). These include social context, individual psychosocial and social developmental factors, sexual behaviors, and biological factors. We will compare the specifics of HIV risks by marital status and age of partners, by school attendance and achievement, and on the basis of pregnancy intentions and desires. Moreover, the umbrella Rakai Health Sciences Program has a well-developed Qualitative Research Department that allows for the exploration of the nuanced pathways between social and developmental factors and HIV infection---including the influence of HIV prevention programs, adolescent life goals and opportunities, peer pressure, relationship dynamics, and other social influences---that are difficult to fully capture in quantitative questionnaires. A second project aim would explore the specific role of HIV policies and programs in influencing HIV incidence among youth in the Rakai District. The RYP will explore changing HIV risk over four key "generations" of HIV prevention and care programs in Uganda: the "Zero grazing" era, the shift to ABC and abstinence education, the post anti-retroviral (ARV) treatment generation, and young people who have come of age after the advent of male circumcision (MC) availability. The new availability of ARVs and MC has raised considerable concerns about behavioral disinhibition among youth. Colleagues from Uganda and the U.S. will work together to synthesize and triangulate these findings. On the basis of the research findings, the RYP will develop recommendations for structural-level and educational interventions for youth in Rakai, Uganda, and elsewhere who are at-risk of HIV infection. Related research dissemination activities will be targeted strategically toward key policy and program leaders at the community, national, and international levels. PUBLIC HEALTH RELEVANCE: The proposed Rakai Youth Project (RYP) would explore the changing patterns of HIV incidence among youth 15-24 years and will assess the influence of social and developmental risk factors for new HIV infections over time. We would use new qualitative data collection and the existing Rakai Community Cohort Study to explore changing risk factors for HIV infection among youth over the period 1994-2012. The RYP would also explore the specific role of HIV policies and programs in influencing HIV incidence among youth in the Rakai District and develop recommendations for structural-level and educational interventions for youth HIV prevention.