Optimizing Delivery of ART/PrEP for HIV Prevention through Qualitative Research

描述（由申请人提供）：2011年是三十年来寻求有效艾滋病毒预防干预措施的转折点。2011年，在撒哈拉以南非洲地区，艾滋病毒感染者的早期抗逆转录病毒治疗（ART）和未感染者的口服抗逆转录病毒暴露前预防（PrEP）在预防艾滋病毒传播方面表现出很高的疗效。抗逆转录病毒疗法和预防性预防措施现在被认为是减少艾滋病毒传播的最有希望的战略之一。现在的注意力正转向制定提供这些新的预防工具的办法。合作伙伴示范项目是有史以来第一个向非洲艾滋病毒1血清不一致夫妇提供ART/PrEP预防的示范项目。该示范使用了一种“桥接战略”，即向符合治疗条件的艾滋病毒感染伙伴提供抗逆转录病毒治疗，并向未感染艾滋病毒的伙伴提供PrEP，作为开始抗逆转录病毒治疗的“桥梁”。我们建议对桥接战略进行定性评估，以告知未来全球实施和扩大ART/PrEP在非洲的预防。该项目发生在乌干达的坎帕拉。评价利用多个参与者群体和数据收集方法进行深入调查。我们将对48对夫妇进行多个定性访谈，这些夫妇是有目的地抽样的，以代表各种桥接策略的经验。访谈将是联合的（合作伙伴一起）和单独的（合作伙伴单独），并与关键的过渡战略相联系。还将对示范项目提供者进行40次访谈，并对项目的护理活动进行40次观察。一种归纳的、以内容为中心的比较分析方法将使我们能够描述夫妇对桥接策略的体验和对ART/PrEP预防的反应（目标1）、夫妇的关系动态（目标2）、提供者的挑战（目标3）以及更广泛的社会、文化和经济背景影响（目标4）。

DESCRIPTION (provided by applicant): The year 2011 marked a turning point in the three-decade search for effective HIV prevention interventions. In 2011, both early antiretroviral therapy (ART) in HIV-infected individuals and oral antiretroviral pre-exposure prophylaxis (PrEP) in uninfected individuals demonstrated high efficacy for protection against HIV transmission when used by members of HIV-1 serodiscordant couples in sub-Saharan Africa. ART and PrEP for prevention are now considered among the most promising strategies for reducing the spread of HIV. Attention is now turning to development of approaches to delivering these new prevention tools. The Partners Demonstration Project is the first-ever demonstration to deliver ART/PrEP for prevention to HIV-1 serodiscordant couples in Africa. The demonstration uses a "bridging strategy" of delivery in which ART is offered to HIV-infected partners eligible for treatment, and PrEP is offered to HIV-uninfected partners as a "bridge" to ART initiation. We propose a qualitative evaluation of the bridging strategy, to inform future global implementation and scale- up of ART/PrEP for prevention in Africa. The project takes place in Kampala, Uganda. The evaluation draws upon multiple participant groups and data collection methods for in-depth investigation. We will carry out multiple qualitative interviews with 48 couples purposefully sampled to represent various bridging strategy experiences. Interviews will be joint (partners together) and individual (partners separately), and linked to key bridging strategy transitions. Forty interviews with Demonstration Project providers and 40 observations of Project activities of care will also be conducted. An inductive, content-focused, comparative analytic approach will allow us to characterize couples' experiences of the bridging strategy and responses to ART/PrEP for prevention (Aim 1), couples' relationship dynamics (Aim 2), provider challenges (Aim 3), and broader social, cultural and economic contextual influences (Aim 4).