Developing a Gender-Enhanced PrEP Information-Motivation Workshop for Young South African Women

南非少女和年轻妇女感染艾滋病毒的风险仍然非常高。 口服暴露前预防（PrEP）有可能改变这一脆弱人群的流行曲线。 人口，有令人信服的证据表明，如果坚持，PrEP对女性有效。然而，一个关键的问题 是否AGYW将采用和坚持口服PrEP的数量足以降低人口发病率。 在有风险的AGYW中产生需求产生兴趣，他们可能对PrEP知之甚少， 使用它是关键。在VOICE试验中驱动不遵守PrEP的障碍-低感知风险， 对服用抗逆转录病毒药物的耻辱感，对生物医学产品的不信任，对潜在副作用的担忧，以及 对伴侣反应的担忧也可能抑制AGYW对口服PrEP的吸收，即使已知有效性。 但是，尽管相当多的研究旨在确定AGYW的坚持支持方法， 我们的注意力集中在创造需求和推动采用上，这是我们要解决的一个差距。我们建议 两项创新可以接触到年轻的，有风险的AGYW，告知他们PrEP并激励他们使用它：（1） 通过性别透镜在一次会议小组研讨会上介绍PrEP;以及（2）同行驱动的招聘- 在性别理论的指导下， 信息动机行为（IMB）模型，并与AGYW的工作组合作，我们将 开发一个单一的基于小组的性别增强研讨会，提供PrEP信息和地址 为了告知干预措施的发展，我们将进行八个重点小组， AGYW（16-25岁）和20次定性访谈（10名艾滋病毒阳性，10名艾滋病毒阴性或未知） 地位）与这个年龄段的妇女合作，将探索知识，信仰，动机， 以及在性别关系动态和PrEP相关污名的背景下使用PrEP的担忧。在 作为试点，我们将比较随机分配到GE或仅提供信息（IO）研讨会的AGYW（N=100）， 接受PrEP临床评估（主要结局）;如果符合PrEP条件，则接受PrEP和3个月PrEP 保留（次要结果）;以及，对于所有女性，假设的中介（风险认知，性别障碍， 同伴规范，自我效能，结果预期，PrEP耻辱，态度，信息）干预后和在 三个月。对于同行驱动招聘（PDR），将随机分配到任一研讨会类型（GE或IO）的AGYW 被邀请成为同伴健康倡导者（PHAs），他们被支付与社交网络成员交谈并推荐 他们到PHA参加的研讨会类型。我们将（1）使用以下方法评估PDR的可接受性和可行性： 预先规定的绩效标准（平均>50%的参与者成为PHA，>2名被招募者/PHA参加 讲习班）;（2）评估PDR的覆盖范围（在新的艾滋病毒风险工具上得分高的百分比;从未 计划生育或计划生育）。如果有希望，这些方法将得到进一步的测试，并可以迅速 按比例扩大，以加强向SA AGYW推广PrEP。

South African adolescent girls and young women (AGYW) remain at extraordinarily high risk of HIV infection. Oral pre-exposure prophylaxis (PrEP) has the potential to alter the epidemic curve in this vulnerable population, given compelling evidence that if adhered to, PrEP is efficacious in women. Yet, a critical question is whether AGYW will adopt and adhere to oral PrEP in numbers sufficient to reduce population incidence. Creating demand—generating interest among at-risk AGYW, who may know little about PrEP and be wary of using it—is critical. The barriers that drove non-adherence to PrEP in the VOICE trial—low perceived risk, stigma around taking ARVs, mistrust of biomedical products, worries about potential adverse effects, and concerns about partner reactions—may also dampen AGYW's uptake of oral PrEP, even given known efficacy. But, whereas considerable research is aimed at identifying adherence support approaches for AGYW, limited attention has focused on creating demand and motivating uptake, a gap we aim to address. We propose that two innovations can reach young, at-risk AGYW, inform them about PrEP and motivate them to use it: (1) introducing PrEP through a gender lens in a one-session group workshop; and (2) peer-driven recruitment— recruiting women to attend the workshop by those who have already attended it. Guided by gender theory and the Information Motivation Behavior (IMB) model, and in collaboration with a Working Group of AGYW, we will develop a single-session group-based Gender-Enhanced Workshop to provide PrEP information and address AGYW's barriers to using it. To inform intervention development, we will conduct eight focus groups with at-risk AGYW (aged 16-25) and 20 qualitative interviews with men (10 HIV-positive, 10 HIV-negative or of unknown status) partnered with women in this age range that will explore knowledge of, beliefs about, motivators for, and concerns about using PrEP in the context of gendered relationship dynamics and PrEP-related stigma. In a pilot, we will compare AGYW (N=100) randomized to GE or to an Information-Only (IO) Workshop on undergoing PrEP clinical assessment (primary outcome); if PrEP-eligible, uptake of PrEP and 3-month PrEP retention (secondary outcomes); and, for all women, hypothesized mediators (risk perception, gender barriers, peer norms, self-efficacy, outcome expectancies, PrEP-stigma, attitudes, information) post-intervention and at 3-months. For Peer-driven recruitment (PDR) AGYW randomized to either workshop type (GE or IO) will be invited to become Peer Health Advocates (PHAs), who are paid to talk to social network members and refer them to the workshop type the PHA attended. We will (1) evaluate acceptability and feasibility of PDR using pre-specified performance criteria (on average >50% attendees become PHAs and >2 recruitees/PHA attend a workshop); and (2) evaluate reach of PDR (percent who score high on a new HIV risk tool; percent who never tested or attended family planning). If promising, these approaches will be further tested and can be rapidly scaled to enhance the roll-out of PrEP to SA AGYW.