Prison PrEP Values Adherence and Implementation in Lusaka (PrEVAIL)

项目摘要 在赞比亚和撒哈拉以南非洲，被监禁者是艾滋病毒流行中心的关键人群之一。 非洲（撒南非洲）。监禁期间和监禁后的时期可能是艾滋病毒风险很大的时期， 然而，人们对这些时期艾滋病毒感染的脆弱性以及如何最好地为被监禁者提供服务知之甚少。 与艾滋病毒预防服务，如暴露前预防（PrEP），以减少艾滋病毒的风险。解决这些 知识差距，我们提出监狱PrEP价值观，坚持，并在卢萨卡实施（PreVAIL） study.我们的科学前提是，提供有效的组合预防监禁和司法- 涉及的人群需要了解他们的艾滋病毒风险和PrEP模式的时间变化 吸收、坚持和持久性。这项工作的长期目标是优化时间和交付， 在赞比亚，作为综合预防的一部分，为涉及司法的人提供PrEP。R21的目标是 描述PrEP吸收，坚持和持久性，以及艾滋病毒风险认知和行为， 在监禁期间和向社区过渡期间参与司法的人。 PreVAIL建立在赞比亚惩教保健研究和服务提供的强大平台上。关于Tasp 一项研究（Co-PI：Herce）是第一个评估SSA监禁人群艾滋病毒普遍检测和治疗的研究， NIH资助的CONTINUUM研究（PI：Herce）是第一个跟踪被监禁者的研究之一， 在SSA发布，CDC/PEPFAR资助的CIRKUITS项目（PI：Claassen，Co-PI：Herce）正在进行 为SSA中涉及正义的人提供PrEP的首批演示之一。 在目标1中，我们将评估PrEP的吸收、依从性和持久性，以及艾滋病毒风险因素， 在监禁期间和释放后，参与司法的人对艾滋病毒风险的看法。我们将 前瞻性地招募一组800名艾滋病毒阴性和符合PrEP条件的被监禁者， 我们将对所有队列成员进行为期12个月的随访，无论PrEP状态如何， 监禁和释放后。主要结果包括PrEP吸收、依从性和持久性， 以及艾滋病毒感染状况、艾滋病毒危险行为和危险认知。PrEP依从性将通过自我报告进行评估 和一种新的即时尿液替诺福韦试验。 在目标2中，我们将使用定性研究方法来探索和理解的障碍和促进因素， PrEP摄取，坚持和监禁期间和释放后的持久性。我们将有目的地 从我们的队列中抽取40名参与者进行理论知情的纵向深入访谈，以了解多方面的 有效使用PrEP的水平障碍和促进因素，以及PrEP方法和服务提供偏好。 这项研究将为非洲涉及司法的人提供新的艾滋病毒风险见解，并量化其程度。 艾滋病毒预防服务连续性方面的差距，导致未来有效的PrEP差异化服务提供 在赞比亚，在监禁和释放后期间，为参与司法的人提供支助的模式。

PROJECT SUMMARY Incarcerated people are one of the key populations at the center of the HIV epidemic in Zambia and sub-Saharan Africa (SSA) in general. The periods during and after incarceration likely represent times of significant HIV risk, yet little is known about HIV infection vulnerability during these times or how best to provide incarcerated people with HIV prevention services such as pre-exposure prophylaxis (PrEP) to reduce HIV risk. To address these knowledge gaps, we propose the Prison PrEP Values, Adherence, and Implementation in Lusaka (PreVAIL) study. Our scientific premise is that providing effective combination prevention to incarcerated and justice- involved populations requires understanding both temporal changes in their HIV risk and patterns of their PrEP uptake, adherence, and persistence. The long-term goal of this work is to optimize the timing and delivery of PrEP, as part of combination prevention, for justice-involved persons in Zambia. The objective of this R21 is to characterize PrEP uptake, adherence, and persistence, as well as HIV risk perceptions and behaviors, among justice-involved persons during incarceration and transition to the community. PreVAIL builds on a robust platform for corrections-health research and service delivery in Zambia. The TasP study (Co-PI: Herce) was the first to assess universal test and treat for HIV for incarcerated people in SSA, the NIH-funded CONTINUUM study (PI: Herce) was one of the first studies to follow incarcerated people after release in SSA, and the CDC/PEPFAR-funded CIRKUITS project (PI: Claassen, Co-PI: Herce) is conducting one of the first demonstrations of PrEP for justice-involved people in SSA. In Aim 1 we will assess PrEP uptake, adherence, and persistence, as well as HIV risk factors and perception of HIV risk, among justice-involved people during incarceration and post-release. We will prospectively enroll a cohort of 800 HIV-negative and PrEP-eligible incarcerated people at prison entry and offer them oral PrEP. We will follow all cohort members for 12 months regardless of PrEP status, both during incarceration and following release. Primary outcomes include PrEP uptake, adherence, and persistence, as well as HIV status, HIV risk behaviors and risk perception. PrEP adherence will be assessed through self-report and a novel point-of-care urine tenofovir test. In Aim 2, we will use qualitative research methods to explore and understand barriers and facilitators of PrEP uptake, adherence, and persistence during incarceration and after release. We will purposively sample 40 participants from our cohort for theory-informed longitudinal in-depth interviews to understand multi- level barriers and facilitators to efficacious PrEP use, as well as PrEP method and service delivery preferences. This study will provide new insights into HIV risk for justice-involved people in Africa and quantify the magnitude of the gap in HIV prevention service continuity, leading to a future, efficacious PrEP differentiated service delivery model to support justice-involved people in Zambia during the period spanning incarceration and post-release.