Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women

项目摘要 我们的首要目标是遏制艾滋病毒流行及其对撒哈拉以南非洲青年的负面影响。 非洲（撒哈拉以南非洲）通过改善多层次组合艾滋病毒的吸收、保留和坚持 由少女和青年妇女及男性伙伴进行预防。南非估计有7.8 100万艾滋病毒感染者。尽管拥有世界上最大的艾滋病毒治疗项目， 少女和青年妇女（15-24岁）的死亡率仍然很高。虽然有 艾滋病毒预防方面的重大创新，例如，通用测试和治疗（UTT）和预暴露 预防（PrEP），这远远超过了提供它们的能力。为了控制艾滋病的流行， * 迫切需要大幅度提高青年女青年和男性对艾滋病毒护理和预防的接受率和保留率 伙伴在这个项目中，我们有一个独特的机会，利用时间敏感的事件，在一个贫穷和农村 夸祖鲁-纳塔尔高流行区：推出八项新的以青年为重点的多层次艾滋病毒预防措施 总统艾滋病紧急救援计划的“坚定、有弹性、有能力、无艾滋病”项目为AGYW及其男性伴侣提供的干预措施， 在最先进的人口和健康状况背景下的指导和安全（梦想）计划 监测，其中有关个人艾滋病毒生物标志物、性行为、艾滋病毒预防和ART暴露的数据 与公共部门的艾滋病临床记录有关。我们通过三个目标实现了这一目标。具体目标1：我们 量化了多个层次的社会动力学如何相互作用，以预测对DREAMS组件的吸收。具体 目的2：我们阐明了个体的生命历程和对梦的接触如何影响对梦的保持和坚持。 艾滋病毒护理和预防。我们发现：a）尽管覆盖率很高，但DREAMS并没有加速艾滋病毒的下降 发病率。B）艾滋病毒发病率下降的原因是男子获得艾滋病毒治疗的机会增加， 青年男子仍然面临障碍。c）性健康需求和自我检测和自我抽样未得到满足的比例很高 很受欢迎d）有针对性的暴露前预防（PrEP）没有达到最危险的AGYW，而同龄人- 航海家做的。具体目标3：确定家庭和同龄人网络战略是否能提高接受率， 青年人坚持综合预防干预措施。我们和年轻人一起审问 调查结果并共同创建干预措施。结果，Thetha Nami（与我交谈）由训练有素的 在督导下，由同侪领航员向青少年提供健康推广服务;方便青少年的临床服务;以及 同侪辅导，以提高艾滋病毒预防的保留率。我们目前正在测试可接受性， * 这种方法在改善青少年和青年接受和保持艾滋病毒护理方面的可行性， 预防我们的多学科团队包括艾滋病毒流行病学家，生物统计学家，社会 科学家，心理学家和南非的干预发展专业知识。展望未来，这将 提供答案：“同龄人和社区一级的干预措施能否充分利用死亡率和艾滋病毒发病率， 降低了撒哈拉以南非洲农村地区青少年和年轻人预防艾滋病毒的潜力？

PROJECT SUMMARY Our overarching goal is to arrest the HIV epidemic and its negative impact on young people in sub-Saharan African (SSA) through improving the uptake, retention, and adherence of multi-level combination HIV prevention by Adolescent Girls and Young Women and male partners. South Africa has an estimated 7.8 million people living with HIV. Despite having the largest HIV treatment program in the world, HIV incidence in Adolescent Girls and Young Women (AGYW aged 15-24) remains high. Whilst there have been significant innovations in HIV prevention, e.g., universal test and treat (UTT) and Pre-exposure prophylaxis (PrEP), this has far outpaced the ability to deliver them. To control the HIV epidemic here is an urgent to significantly improve uptake and retention of HIV care and prevention by AGYW and male partners. In this project we had a unique opportunity to leverage time-sensitive events in a poor and rural hyperendemic area of KwaZulu-Natal: The roll out of eight new youth-focused multi-level HIV prevention interventions for AGYW and their male partners by PEPFAR’s Determined, Resilient, Empowered, AIDS free, Mentored, and Safe (DREAMS) program in the context of a state of the art demographic and health surveillance, where data on individual HIV biomarkers, sexual behaviors, HIV prevention and ART exposure are linked to public-sector clinical records for HIV. We achieved this through three aims. Specific aim 1: We quantified how multiple levels of social dynamics interact to predict uptake of DREAMS components. Specific aim 2: We elucidated how individuals’ life-course and exposure to DREAMS affect retention and adherence to HIV care and prevention. We found that: a) Despite high coverage, DREAMS did not accelerate decline in HIV incidence. b) HIV incidence decline were explained by increases in men’s access to HIV treatment, although barriers remain for young men. c) There is a high unmet sexual health need and self-testing, and self-sampling were popular. d) Targeted Pre-Exposure prophylaxis (PrEP) didn’t reach AGYW most at risk, whilst peer- navigators did. Specific aim 3: Ascertain whether family- and peer-network strategies improve uptake and adherence to combination prevention interventions by young people. We worked with youth to interrogate the findings and co-create an intervention. The result, Thetha Nami, (Talk to Me) consists of trained and supervised peer-navigators who provide health promotion to young people; youth-friendly clinical services; and peer-mentorship to improve retention in HIV prevention. We are currently testing the acceptability and feasibility of this approach on improving adolescents and youth uptake and retention of HIV care and prevention. Our multidisciplinary team includes HIV epidemiologists, a biostatistician, social scientists, psychologist, and intervention development expertise in South Africa. Moving forward, this will provide answers to: ‘Can peers and community-level interventions harness the full mortality and HIV incidence reducing potential of HIV prevention for adolescents and young people in rural SSA?’