Improving HIV Care Engagement Among Ugandan Adolescent Girls and Young Women Through Reductions in Male Partner Alcohol Use and Intimate Partner Violence Risk: The Kisoboka Mukwano Intervention

项目总结/摘要 在乌干达，少女和年轻妇女（AGYW）受艾滋病毒影响的比例过高， 病毒抑制率低，增加了进一步传播的风险。亲密伴侣暴力（IPV） 艾滋病毒对青年女青年的影响的主要障碍。感染艾滋病毒的青年男女， 经历过IPV的撒哈拉非洲（SSA）患者的药物依从性、病毒抑制和 比那些没有IPV的人更关心工作。此外，男性伴侣饮酒直接和间接增加 撒南非洲青年女青年中的IPV风险。因此，一项干预措施，包括解决酗酒问题的成分， 在男性伴侣中，可以降低AGYW的IPV风险，特别是在乌干达，那里的酒精含量最高。 人均使用量。以夫妇为基础的干预措施有效地减少了男性伴侣的饮酒， 关系冲突IPV，并改善病毒抑制和艾滋病毒护理参与;然而，没有一个 为撒哈拉以南非洲的AGYWLHIV量身定制。我们建议制定和试行一项以夫妇为基础的干预措施， 通过减少大量饮酒，改善AGYWLHIV患者的艾滋病毒护理参与和抗逆转录病毒疗法依从性 男性伴侣和夫妇IPV风险。此外，我们将探讨干预对AGYW的影响 病毒载量作为预防治疗的额外关键益处。我们的目标是：1）适应行为 一个简短的基于MI的酒精干预的组成部分，以创建拟议的Kisoboka Mukwano（“它是 我的爱！”干预干预措施将促进减少男性伴侣的战略， 酒精使用，应对关系冲突和压力，改变降低IPV和支持的规范 参与艾滋病毒护理和AGYWLHIV之间的抗逆转录病毒疗法坚持，从而加强未来的持续 病毒抑制和治疗作为预防的益处。干预措施将根据需要进行调整和调整， 与异性恋夫妇一起交付，涉及同伴导航员，解决IPV，并在发展中 适合乌干达的AGYWLHIV。我们将与联合国开发计划署合作， 干预指导委员会通过：对已婚/同居AGYWLHIV的定性研究， 已婚/同居男性，和关键的线人和初步试点测试6对夫妇。2)我们将评估安全性， 可接受性，可行性和初步估计的潜在干预措施，相比， 对照组，以改善艾滋病毒，酒精和IPV的结果。我们将检查对AGYW的初步影响 艾滋病毒护理参与，AGYW ART坚持，男性伴侣中的重度酒精使用，以及夫妇IPV 风险和探索对AGYW病毒载量的影响以及与干预相关的中间结果 件.我们将在基线以及3个月和6个月随访时评估这些结局。研究 研究结果将用于指导随后的R 01提案，以在更大的临床试验中测试干预措施。

PROJECT SUMMARY / ABSTRACT In Uganda, adolescent girls and young women (AGYW) are disproportionately affected by HIV and have poor viral suppression rates, increasing their risk of onward transmission. Intimate partner violence (IPV) is a major barrier to mitigating the impact of HIV among AGYW. AGYW living with HIV (AGYWLHIV) in sub- Saharan Africa (SSA) who have experienced IPV have worse medication adherence, viral suppression, and care engagement than those without IPV. Further, male partner alcohol use directly and indirectly increases IPV risk among AGYW in SSA. Thus, an intervention with components that address heavy alcohol use among male partners could decrease AGYW’s IPV risk, especially in Uganda, which has the highest alcohol use per capita in SSA. Couples- based interventions have effectively reduced male partner alcohol use, relationship conflict IPV, and improved viral suppression and HIV care engagement; yet, none have been tailored to AGYWLHIV in SSA. We propose to develop and pilot a couples-based intervention that focuses on improving HIV care engagement and ART adherence among AGYWLHIV by reducing heavy alcohol use among male partners and couple IPV risk. Additionally, we will explore the intervention’s effects on AGYW viral load for the additional key benefit of treatment as prevention. Our aims are to: 1) Adapt the behavioral components of a brief MI-based alcohol intervention to create the proposed Kisoboka Mukwano (“It is possible, my love!”) intervention. The intervention will promote strategies for reductions in male partner alcohol use, coping with relationship conflict and stress, changing norms that reduce IPV and support engagement in HIV care and ART adherence among AGYWLHIV, and, thereby, enhance future sustained viral suppression and benefits of treatment as prevention. The intervention will be adapted and tailored to be delivered with heterosexual couples, involve peer navigators, address IPV, and be developmentally appropriate for AGYWLHIV in Uganda. We will develop and refine the intervention in collaboration with an intervention steering committee through: qualitative research with married/cohabiting AGYWLHIV, married/cohabiting men, and key informants and an initial pilot test with 6 couples. 2) We will assess safety, acceptability, feasibility, and preliminary estimates of the potential for the intervention, as compared to the control group, to improve HIV, alcohol, and IPV outcomes. We will examine preliminary effects on AGYW HIV care engagement, AGYW ART adherence, heavy alcohol use among male partners, and couple IPV risk and explore effects on AGYW viral load as well as intermediate outcomes related to intervention components. We will assess these outcomes at baseline and then at 3- and 6-month follow-up. Study findings will be used to guide a subsequent R01 proposal to test the intervention in a larger clinical trial.