Acceptability of PrEP for HIV Prevention among HIV-positive and HIV-negative Adolescents

 描述(申请人提供)：口服抗逆转录病毒(ARV)暴露前预防(PrEP)在扩大青少年预防战略方面具有巨大潜力，青少年占全球所有新感染病例的39%。我们迫切需要开展PrEP作为青少年预防策略的探索性研究，因为越来越多的证据表明成人PrEP的安全性和部分有效性，同时最近启动了初步的青少年安全性试验。我们提议进行一项探索性R21研究，以调查南非青少年和临床医生对PrEP的理解。南非是艾滋病毒携带者人数最多的国家。这项研究可以通过提高我们对行为和社会过程的理解来推动艾滋病毒预防科学的发展，这些过程可能会加强青少年PrEP试验的未来实施，并通过关于PrEP安全性和有效性的有效信息来优化将临床研究结果转化为公共卫生实践。青少年经历了独特的发展阶段，这些阶段可能会影响PrEP的可接受性、使用或支持他人使用PrEP的意愿、对PrEP有效性的信息的理解，以及以不同于成年人的方式做出行为决定。我们专注于流行环境，以利用青少年在血清不协调关系中导航的教训，并捕捉围产期感染儿童的PrEP相关经验，这些儿童面临着与遵守ARV相关的挑战，平衡血清不一致伴侣的感染风险与启动性行为的决定，以及生育欲望。我们比较了HIV阳性和HIV阴性青少年对PrEP的理解，因为可接受性、使用或支持伴侣使用的意愿，以及预测的PrEP的行为影响可能因HIV状况而异。我们探索青少年如何解释来自成人试验的PrEP部分疗效的信息，以及对PrEP疗效的期望如何影响摄取、依从性和风险补偿。我们对青少年和临床医生的观点进行三角划分，并探讨临床医生对在资源受限的地方性环境中实施PrEP的潜在障碍和促进者的看法。我们的近期目标是了解影响青少年PrEP试验安全性、可行性和有效性设计的青少年特有因素(D18岁)，并开发一个初步的经验概念模型来指导青少年定制PrEP消息传递以防止行为去抑制。我们提出了三个目标：1)使用HIV阳性和HIV阴性青少年的焦点小组(k=6-10)来探索知识、可接受性、使用PrEP的意愿或支持伴侣使用，以及基于成人疗效试验的PrEP教育如何影响吸收、依从性和风险补偿；2)使用对青少年的深度访谈(n=24-32)，更深入地探索目标1主题，并探索敏感问题，如污名和披露可能如何影响PrEP的可接受性；3)通过对临床医生的个别访谈(n=20-30)，了解青少年PrEP的意见、开处方的意愿、实施PrEP的障碍和促进者，以及在未来开展PrEP时如何支持坚持和保护行为。

 DESCRIPTION (provided by applicant): Oral antiretroviral (ARV) pre-exposure prophylaxis (PrEP) holds enormous potential for expanding prevention strategies for adolescents, who account for 39% of all new global infections. We urgently need to engage in exploratory research of PrEP as an adolescent prevention strategy given growing evidence on safety and partial efficacy of adult PrEP accompanied by the recent launch of initial adolescent safety trials We propose an exploratory R21 study to investigate adolescents' and clinicians' understandings of PrEP in South Africa, the country with the largest number of people living with HIV. This research can advance HIV prevention science by improving our understanding of the behavioral and social processes that may potentiate future implementation of adolescent PrEP trials, and to optimize the translation of clinical findings into public health practice through effective messaging about PrEP safety and efficacy. Adolescents undergo unique developmental milestones which are likely to influence PrEP acceptability, willingness to use or to support others' use of PrEP, understandings of messages about PrEP effectiveness, and behavioral decisions in different ways than adults. We focus on endemic settings to leverage lessons from adolescents navigating serodiscordant relationships and to capture PrEP relevant experiences of perinatally infected children who confront challenges relating to ARV adherence, balancing risk for infection of serodiscordant partners with decisions to initiate sex, and fertility desires We compare HIV-positive and HIV-negative adolescents' understandings of PrEP since acceptability, willingness to use or to support partner's use, and predicted behavioral impacts of PrEP may vary by HIV status. We explore how adolescents interpret messages of PrEP partial efficacy as derived from adult trials, and how expectations of PrEP efficacy might affect uptake, adherence, and risk compensation. We triangulate adolescent and clinician perspectives, and explore clinician's views on potential barriers and facilitators in PrEP implementation in resource-constrained endemic settings. Our immediate goals are to understand adolescent-specific factors that affect the design of safety, feasibility, and efficacy of PrEP trials for adolescents (d18 years) and to develop an initial empirical conceptual model to guide adolescent-tailored PrEP messaging to prevent behavioral disinhibition. We propose three aims: 1) to use focus groups (k = 6-10) with HIV-positive and HIV-negative adolescents to explore knowledge, acceptability, willingness to use PrEP or to support partner use, and how about PrEP education based on adult efficacy trials may influence uptake, adherence, and risk compensation; 2) to use in-depth interviews (n = 24- 32) with adolescents to explore Aim 1 topics in more depth and to probe for sensitive issues such as how stigma and disclosure might affect acceptability of PrEP; and 3) to use individual interviews (n = 20-30) with clinicians to understand opinions of PrEP, willingness to prescribe, barriers and facilitators for implementing PrEP, and how to support adherence and protective behaviors during future rollout of adolescent PrEP.