HIV Prevention among Young Female Sex Workers: an Implementation Research Approach

 描述(由申请者提供)：这个为期四年的K01导师研究科学家发展奖将为我提供高级培训和指导，使我成为实施研究的独立调查员，整合流行病学、社会科学和经济学的方法，以增加年轻女性性工作者(FSW)对艾滋病毒预防服务的参与度。我的长期目标是成为执行研究的主要调查者，解决难以接触到的人群在艾滋病毒预防和护理方面的健康差距，重点是年轻的关键人群。拟议的工作包括利用RTI International丰富的跨学科研究环境进行培训和研究。培训是这一提议的基础，包括高级导师和顾问，他们具有互补的专业知识、教学教育、技能发展和指导研究，以便在完成奖项时，我将为独立的研究生涯做好准备。培训计划是与指导研究计划同时制定的，以确保新获得的知识和技能立即应用于研究项目的相关方面。在本奖项期间，将实现以下目标：(1)获得实施研究方法方面的培训和实用技能，包括改进和评估综合保健干预措施实施和交付的方法，以增加年轻主要人群对服务的需求、接受、保留和遵守；(2)获得综合保健干预措施成本计算和成本效益分析方面的培训和实用技能；(3)成为实施研究中的独立调查员，通过出版科学出版物、在专题专家的指导下为该领域作出贡献，并为未来的R系列奖项拟订试点数据。拟议研究部分的目标是全面评估津巴布韦针对25岁青年的艾滋病毒预防项目，以确定导致最高吸收率、保留率和遵从性的交付方法。与年长的妇女相比，年轻的妇女是感染艾滋病毒的风险更大的弱势群体，但他们参与艾滋病毒服务的程度仍然很低。现已获得资金，以实施一项针对年轻妇女的循证艾滋病毒预防试点项目，该项目纳入津巴布韦的国家性工作者方案(NSWP)诊所。这项研究将综合评估8个NSWP诊所的试点项目，受益于全国所有36个NSWP地点可用的基础设施、资源和丰富的规划数据。具体目标是：(1)确定实施和采用艾滋病毒预防试点项目的障碍和促进者；(2)采用随机阶梯式楔形设计实施和评估试点项目；(3)估计不同艾滋病毒预防组成部分的成本和成本效益。这项研究将提供定量和定性的证据，以确定未来是否有必要对SCAE UP进行试验，并评估干预的有效性/成本效益。

 DESCRIPTION (provided by applicant): This four-year K01 Mentored Research Scientist Development Award will provide me with advanced training and mentorship to become an independent investigator in implementation research, integrating methods from epidemiology, social science, and economics to increase engagement of young female sex workers (FSW) in HIV prevention services. My long-term goal is to become a leading investigator in implementation research that addresses health disparities in HIV prevention and care among hard-to-reach populations, with a focus on young key populations. The proposed work includes training and research that capitalize on the rich interdisciplinary research environment of RTI International. Training represents the foundation of this proposal and includes senior mentors and advisors with complementary expertise, didactic education, skills development, and mentored research so that at the completion of the award I will be well positioned for an independent research career. The training plan was developed in parallel with the mentored research plan to ensure that newly acquired knowledge and skills are immediately applied to the relevant aspects of the research project. The following objectives will be accomplished during this award: (1) obtain training and practical skills in implementation research methods, including methods to improve and evaluate implementation and delivery of combination health interventions in order to increase demand, uptake, retention and compliance to services by young key populations; (2) obtain training and practical skills in costing and cost-effectiveness analysis of combination health interventions; (3) become an independent investigator in implementation research by contributing to the field through scientific publications, being mentored by subject matter experts, and generating pilot data for a future R-series award. The goal of the proposed research component is to comprehensively evaluate a multicomponent HIV prevention project in Zimbabwe targeting young FSW <25 years of age, to determine methods of delivery that result in the highest uptake, retention, and compliance. Young FSW are a vulnerable population at greater risk for HIV acquisition than their older counterparts, yet thei engagement in HIV services remains low. Funding has been secured to implement an evidence-based, HIV prevention pilot project for young FSW, integrated within Zimbabwe's National Sex Worker Programme (NSWP) clinics. This research will comprehensively evaluate the pilot project at 8 NSWP clinics, benefitting from the infrastructure, resources, and wealth of programmatic data available from all 36 NSWP sites nationally. Specific aims are to: (1) determine barriers and facilitators to implementation and uptake of the HIV prevention pilot project; (2) implement and evaluate the pilot project using a randomized stepped wedge design; and (3) estimate the cost and cost-effectiveness of the different HIV prevention components. This study will provide quantitative and qualitative evidence to determine if a future trial to scae up and evaluate the intervention's effectiveness/cost-effectiveness is warranted.