IPrEP: A Combination HIV Prevention Strategy for Young Women at Risk for HIV

 描述(由申请人提供)：撒哈拉以南非洲(SSA)艾滋病毒普遍流行的关键人群没有得到足够的关注，包括女性性工作者(FSWs)，这一群体的艾滋病毒流行率大大高于一般人口，也是肯尼亚艾滋病毒流行的主要贡献者。年轻的性服务工作者(18-24岁)是一个弱势群体，是性服务工作者中风险最高的群体，需要量身定做的生物医学、行为和结构干预措施，以应对他们面临的流行病学和背景复杂性。我们提出了iPrep研究项目，其中包括：1)形成性研究，包括对年轻FSWs、男性客户(MC)的定性研究，以阐明生活挑战、动机和对艾滋病毒风险的认知；危险行为；关于艾滋病毒和艾滋病毒预防的知识、态度，包括PrEP；对坚持支持的偏好；以及性伴侣关系。与卫生保健提供者(HCP)的访谈将评估有关艾滋病毒预防和PrEP的知识以及对FSWs的态度；2)在年轻FSWs中进行一项加强的暴露前预防(PrEP)研究，以确定PrEP这一生物医学干预措施与行为和结构性依从性干预(同伴支持与提醒和资源转移)和减少风险咨询干预相结合的策略的接受度、依从性、可行性和可接受性；3)招募和保留MC的可行性研究，评估降低风险咨询干预的可接受性；4)与内罗毕大学(UON)合作，对PrEP综合战略进行成本效益分析，以便为实施和推广提供信息；5)利用PEPFAR护理教育伙伴行动(NEPI)的经验和基础设施，为UON护士教职员工和学生开展实施研究方面的能力建设。拟议的研究有几个创新之处，包括关注年轻的FSW，这是肯尼亚艾滋病毒地理热点地区的高危人群，以及MCs和HCP，他们在FSWs获得预防服务和预防方法方面发挥关键作用。这项研究包括实施理论驱动的组合预防战略，包括生物医学、行为和结构性干预措施，以及旨在减少性风险补偿和危险行为的干预措施；评估HCP对艾滋病毒预防的知识和态度，包括PrEP和FSWs；成本效益分析，为PEPFAR支持的计划的实施和扩大提供信息，以及致力于建设能力，以设计、实施和分析与护理合作伙伴合作的实施研究结果。我们研究的最终目标是确定如何有效地为这些面临艾滋病毒严重风险的年轻人实施预防艾滋病方案，从而降低他们感染艾滋病毒的风险，从而减少肯尼亚和类似环境中新感染艾滋病毒的总人数。这项研究的结果也将为PEPFAR提供信息，因为它的目标是通过有效使用循证干预措施来阻止艾滋病毒的传播。

 DESCRIPTION (provided by applicant): Key populations within the generalized HIV epidemic in sub-Saharan Africa (SSA) have received insufficient attention including female sex workers (FSWs), a group with HIV prevalence substantially higher than the general population and a major contributor to the HIV epidemic in Kenya. Young FSWs (18-24 years old), a vulnerable population, are at highest risk among FSWs and require tailored biomedical, behavioral and structural interventions to counter the epidemiological and contextual complexities they face. We propose the IPrEP Research Project which includes: 1) formative research, inclusive of qualitative research among young FSWs, male clients (MCs) to elucidate life challenges, motivations and perceptions of HIV risks; risk behaviors; knowledge, attitudes about HIV and HIV prevention, including PrEP; preferences for adherence support; and sex partner relations. Interviews with health care providers (HCPs) will assess knowledge regarding HIV prevention and PrEP and attitudes towards FSWs; 2) an enhanced oral pre-exposure prophylaxis (PrEP) study among young FSWs to determine the uptake, adherence, feasibility and acceptability of combination strategy of PrEP, a biomedical intervention, with behavioral and structural adherence interventions (peer support versus reminders and resource transfer) and risk-reduction counseling intervention; 3) feasibility study for recruitment and retention of MCs with assessment of acceptability of risk-reduction counseling intervention; 4) cost-effectiveness analysis in collaboration with University of Nairobi (UoN) of the combination PrEP strategies to inform implementation and scale-up and 5) capacity building in implementation research for nurse faculty and students at UoN building on PEPFAR Nursing Education Partnership Initiative (NEPI) experience and infrastructure. The proposed research is distinguished by several innovations, including focus on young FSW, a population a high risk in a geographic HIV hotspot in Kenya, as well as on MCs and HCPs who play key roles in access by FSWs to prevention services and to prevention methods. The research includes implementation of theoretically- driven combination prevention strategies inclusive of biomedical, behavioral and structural interventions and an intervention aimed to decrease sexual risk compensation and risk behaviors; the assessment of HCPs' knowledge and attitudes regarding HIV prevention, including PrEP, and FSWs; cost-effectiveness analysis to inform implementation and scale-up within PEPFAR-supported programs, as well as a commitment to building capacity to design, implement and analyze findings from implementation studies working with nursing partner. The ultimate goal of our research is to identify how PrEP can be effectively implemented for this young population at substantial risk for HIV decreasing their risk of HIV acquisition, consequently diminishing the overall number of new HIV infections in Kenya and similar settings. Findings from this research will also inform PEPFAR as it aims to stem the spread of HIV through the effective use of evidence-based interventions.