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

描述（由申请人提供）：2011年是三十年来寻找有效的艾滋病预防干预措施的一个转折点。2011年，撒哈拉以南非洲地区艾滋病毒-1血清不一致的夫妇使用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），均显示出防止艾滋病毒传播的高效率。抗逆转录病毒治疗和预防准备现在被认为是减少艾滋病毒传播的最有希望的战略。现在的注意力转向制定提供这些新的预防工具的方法。合作伙伴示范项目是第一个向非洲艾滋病毒-1血清不一致的夫妇提供抗逆转录病毒治疗/PrEP预防的示范项目。该示范使用了一种提供的“桥梁战略”，即向有资格接受治疗的艾滋病毒感染伙伴提供抗逆转录病毒药物，并向未感染艾滋病毒的伙伴提供预防措施，作为开始抗逆转录病毒药物治疗的“桥梁”。我们建议对衔接战略进行定性评估，为未来在非洲实施和扩大抗逆转录病毒治疗/PrEP预防提供信息。该项目在乌干达的坎帕拉进行。该评估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对夫妇进行多次定性访谈，有目的地抽样，以代表各种桥梁策略经验。面试将是联合的（合作伙伴一起）和单独的（合作伙伴单独），并与关键的过渡性战略过渡联系起来。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。一个归纳的、以内容为中心的、比较分析的方法将使我们能够描述夫妇对桥接策略的经历和对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).