Evaluation of the Implementation of PrEP Provision for Ugandan Fisherfolk

项目总结 在乌干达渔民社区，艾滋病毒流行率比乌干达高出一个数量级 普通人口和渔民中艾滋病毒的高流行率有助于推动这一普遍流行。在前一次 R21研究，我们证明了将艾滋病毒检测带到渔民社区，那里的医疗设施 稀缺的，可以识别出大量艾滋病毒阴性的高危渔民。对艾滋病毒产生重大影响 在渔民中流行流行病，这项研究计划的下一步关键是提供预先接触 预防(PrEP；一种含有替诺福韦和恩曲他滨的高效、安全的日常药片，用于预防艾滋病毒) 艾滋病毒检测后的高危艾滋病毒阴性渔民。虽然2016年乌干达艾滋病毒预防和 治疗指南建议将PrEP用于渔民预防艾滋病毒，目前尚无政府 支持在渔民社区实施PrEP。迫切需要试点数据来证明 乌干达卫生部表示，PrEP可以可行地交付给渔民，以确保政府 为渔民提供PrEP支持。具体目标是：(1)开展形成性质化研究 PrEP吸收的障碍和促进者，并就可接受的PrEP消息传递和提供获得投入， 对乌干达维多利亚湖上的渔民社区；和(2)进行混合方法分析比较 渔民社区以社区为基础与以医疗机构为基础的PrEP实施情况 在乌干达维多利亚湖上。对于这两种PrEP干预措施，我们将每月进行艾滋病毒检测和PrEP，并 抗逆转录病毒治疗提供活动，利用形成工作中形成的信息来筹集 对PrEP的认识。在测试期间，将向维多利亚湖两个登陆点的100名渔民提供Prep 每月指定日期的活动：在一个地点，PrEP将在期间在附近的医疗机构分发 每月的活动，在另一个网站，PrEP将被分发在一个临时的社区空间。其中包括 未遵守者(基于重新灌装数据)，PrEP条款将通过PrEP交付补充到 社区卫生工作者或在社区PrEP接待点，基于在形成过程中引发的策略 工作。为了评估实施情况，我们将对医疗保健提供者进行半结构化访谈，并 渔民决定和不决定启动PrEP，并获得医疗记录数据以比较 渔民比例：确认为符合PrEP资格，发起PrEP，坚持PrEP(即，重新填充超过6 Mo.)，谁血清转换，谁停止PrEP，总体上和按社会人口学特征(例如， 性别)。我们将在整个研究过程中与乌干达卫生部的政策制定者接触，以保持他们 通报结果，并确定渔民未来围绕PrEP的政策方向。要实现90-- 90-90个目标，关键是寻找最难达到的、最危险的人群，如渔民，他们 居住和工作在不容易获得医疗保健的地区。

PROJECT SUMMARY In Ugandan fisherfolk communities, HIV prevalence is an order of magnitude higher than in the Ugandan general population, and high HIV prevalence among fisherfolk helps to drive the general epidemic. In a prior R21 study, we demonstrated that bringing HIV testing to fisherfolk communities, where healthcare facilities are scarce, can identify a large number of high-risk HIV-negative fisherfolk. To have a significant impact on the HIV epidemic among fisherfolk, a key next step in this research program would be to offer pre-exposure prophylaxis (PrEP; a highly effective and safe daily pill containing tenofovir and emtricitabine to prevent HIV) to high-risk HIV-negative fisherfolk following HIV testing. Although the 2016 Ugandan HIV prevention and treatment guidelines recommend PrEP for HIV prevention in fisherfolk, there is currently no governmental support for PrEP implementation in fisherfolk communities. Pilot data are urgently needed to demonstrate to the Ugandan Ministry of Health that PrEP can be feasibly delivered to fisherfolk, in order to secure government support for PrEP for fisherfolk. The Specific Aims are: (1) To conduct formative qualitative research to examine barriers to and facilitators of PrEP uptake, and to obtain input on acceptable PrEP messaging and provision, for fisherfolk communities on Lake Victoria, Uganda; and (2) To conduct a mixed-methods analysis comparing the implementation of community-based vs. healthcare facility-based PrEP provision for fisherfolk communities on Lake Victoria, Uganda. For both PrEP interventions, we will conduct monthly HIV testing and PrEP and antiretroviral treatment provision events, using messages developed from the formative work to raise awareness about PrEP. PrEP will be offered to 100 fisherfolk in two Lake Victoria landing sites during testing events on specified days of the month: In one site, PrEP will be distributed in a nearby healthcare facility during monthly events, and in the other site, PrEP will be distributed in a temporary community space. Among those who are non-adherent (based on refill data), PrEP provision will be supplemented via PrEP delivery by community health workers or at community PrEP pick-up points, based on strategies elicited in the formative work. To evaluate implementation, we will conduct semi-structured interviews with healthcare providers and fisherfolk who do and do not decide to initiate PrEP, and obtain medical records data to compare the proportion of fisherfolk: identified as PrEP-eligible, who initiate PrEP, who adhere to PrEP (i.e., refills over 6 mos.), who seroconvert, and who discontinue PrEP, overall and by socio-demographic characteristics (e.g., gender). We will engage with Ugandan Ministry of Health policymakers throughout the research, to keep them apprised of results and to determine directions for future policy around PrEP for fisherfolk. To realize the 90- 90-90 goals, it is critical to seek out the hardest to reach, most at-risk populations such as fisherfolk, who reside and work in areas without easy access to healthcare.