Improving uptake and adherence to HIV prevention services with PrEP, HIV self-testing and adherence support for very high risk HIV-negative young women aged 15-24 in Kampala, Uganda

项目摘要 撒哈拉以南非洲是世界上增长最快、最年轻的人口所在地， 全球艾滋病毒感染率最高的国家。南非一半以上的人口年龄在25岁以下， 年龄联合国人口基金（人口基金）将10-24岁的男女定义为“青年”， 占南非人口的三分之一，这一比例还在继续增长。在南非的年轻妇女， 在经济和教育上处于不利地位的人从事性交易的风险很高。性工作者 16岁以下的性工作新手比年长的同事更容易受到暴力、性传播感染和艾滋病毒的侵害。作为 性工作在乌干达是非法的，这增加了这些年轻妇女面临的风险。有效的性传播感染和艾滋病毒 预防、护理、支助和生殖健康服务至关重要。解决问题的干预措施的证据 高危人群接受和坚持艾滋病毒预防服务的情况有限，但 地址YWHR几乎不存在。为了响应RFA-MH-17-560，我们建议使用R34来开发 对15至24岁未感染艾滋病毒的妇女进行全面干预，包括PrEP和艾滋病毒自我检测 在乌干达的坎帕拉从事高风险性活动的人，并进行了一项试点试验，以评估其可行性， 可接受性和对PrEP吸收和依从性以及重复HIV自我检测的潜在影响。我们将 将本研究嵌入我们现有的队列研究（NIMH R 01 HD 085805 -01，PI King）中，该研究揭示了 鉴于早期结果，需要更多地关注刚开始从事这一职业的年轻性工作者 在我们的动员努力中，艾滋病毒的流行率比预期高得多。干预将 重点是增加PrEP的启动，加强依从性支持，通过自我重复进行艾滋病毒检测， 测试，并采取和维持减少性传播疾病，艾滋病毒和计划外性行为风险的动机 怀孕具体目标是：（1）进行形成性研究，以提高我们对 社会和性网络的动态，以及从事高风险性行为的妇女（15-24岁）的背景 行为在坎帕拉，乌干达和障碍和机会的准备摄取和遵守，以及重复 通过自我检测进行艾滋病毒检测;（2）制定和测试社会和文化上可接受的可行预防措施 对艾滋病毒高风险年轻妇女采取和坚持PrEP和艾滋病毒自我检测的干预措施;（3） 将试点研究中的经验教训转化为更大规模RCT的设计。拟议的项目是响应 总统艾滋病紧急救援计划和世界卫生组织的几个优先领域 在年轻人中预防艾滋病毒。我们的建议是最早的研究之一， 在高危青年妇女中采取生物行为-结构综合方法预防艾滋病毒， 有限的设置。

PROJECT SUMMARY Sub-Saharan Africa (sSA) is home to the fastest growing and youngest population in the world and includes countries with the highest HIV prevalence globally. More than half of sSA's population is under 25 years of age. Men and women aged 10-24, defined as `young people' by the United Nations Population Fund (UNFPA), represent one third of the sSA population and this proportion continues to grow. Young women in sSA who are economically and educationally disadvantaged are at high risk of engaging in transactional sex. Sex workers under 16, new to sex work are much more vulnerable than their older colleagues to violence, STIs and HIV. As sex work is illegal in Uganda, this contributes to the risk these young women face. Effective STI and HIV prevention, care, support, and reproductive health services are critical. Evidence on interventions that address uptake and adherence to HIV prevention services for high-risk populations is limited, but interventions that address YWHR are almost non-existent. In response to RFA-MH-17-560, we are proposing a R34 to develop a comprehensive intervention including PrEP and HIV self-testing for HIV-uninfected women 15- to 24-years old who engage in high-risk sexual activity in Kampala, Uganda, and conduct a pilot trial to evaluate its feasibility, acceptability and potential effect on PrEP uptake and adherence as well as repeat HIV self-testing. We will embed this study within our existing cohort study (NIMH R01 HD085805-01, PI King) that has revealed the need for greater attention to young sex workers soon after their initiation into the profession given early results in our mobilization efforts that have shown much higher HIV prevalence than expected. The intervention will focus on increasing initiation of PrEP with enhanced adherence support, uptake of repeat HIV testing by self- test, and motivation to adopt and sustain sexual risk reduction behaviors for STI, HIV, and unplanned pregnancy. The specific aims are (1) To conduct formative research to enhance our understanding of the dynamics of the social and sexual networks, and context of women (aged 15-24) engaged in high risk sexual behavior in Kampala, Uganda and barriers and opportunities for PrEP uptake and adherence as well as repeat HIV testing by self test; (2) To develop and test a socially and culturally acceptable and feasible prevention intervention on uptake and adherence to PrEP and HIV self-testing for young women at high risk for HIV; (3) to translate lessons learned in the pilot study into the design of a larger RCT. The proposed project is responsive to several priority areas of the President's Emergency Plan for AIDS Relief and the World Health Organization regarding HIV prevention among young people. Our proposal represents one of the first studies to develop an integrated bio-behavioral-structural approach to HIV prevention among young women at high risk in resource- limited settings.