Social and psychological predictors of PrEP adherence among adolescent girls and young women in Eastern and Southern Africa

项目摘要 青少年和年轻人占全球艾滋病毒新感染者的三分之一以上，占 预防工作的关键人群。在撒哈拉以南非洲，少女和年轻妇女(15-24岁) 感染艾滋病毒的可能性是男性的两倍以上，并对 占该地区所有新增艾滋病毒感染者的近25%。抗逆转录病毒暴露前预防，或PrEP，有 在临床试验中被发现是一种有效的生物医学艾滋病毒预防策略，具有巨大的 有可能减少全球主要人群感染艾滋病毒的机会。然而，在非洲年轻女性中， 观察到了一系列依从性结果，低依从性会损害PrEP的疗效 几条小路。此外，18岁以下的青少年在初级教育方案中的代表性仍然不足。 研究，对理解如何向有以下问题的年轻人提供PrEP提出了重大挑战 专注于最大限度地遵守。需要进行研究以确定与以下方面相关的具体考虑因素 在普遍的艾滋病毒流行环境中，在青春期女孩和年轻妇女中实施预防艾滋病方案。 本研究的目的是考察PrEP使用和抑郁的披露如何影响持续的 东部和南部青春期女孩和年轻妇女坚持每日口服PrEP 非洲。本研究的具体目的是：(1)考察PrEP披露与上市公司业绩之间的关系 用于父母、伴侣和同龄人以及PrEP的延续和依从性；以及(2)确定抑郁是否 与PrEP的延续和坚持有关。这项研究将利用以下纵向队列数据 Empower，一项在年轻女性中进行的多地点前瞻性PrEP实施研究，网址为 在南非约翰内斯堡和坦桑尼亚的姆万扎，艾滋病毒感染的风险很大。418个样本 来自赋权队列的青春期女孩和年轻妇女(16-24岁)，开始每天口头交流 Prep将被包括在这次调查中。每季度对参与者进行长达15个月的跟踪调查。 主要的研究结果是PrEP的依从性，将使用干燥剂中的药物水平进行回顾性测量 用于PrEP使用的生物学评估的血点样本。这项调查有助于向PrEP提供信息 在青春期女孩和年轻妇女中实施战略，通过深入了解 以及有助于坚持的心理动力。为这项研究的成功实施提供支持 计划并促进申请者成长为独立调查员，在 研究金期间将寻求加强申请者的合作研究网络，量化 分析技能，以及跨学科的主题知识。总之，这项拟议的研究和 培训计划将为申请人未来的职业生涯奠定基础，成为独立资助的 流行病学家专注于全球卫生和艾滋病毒预防研究。

PROJECT ABSTRACT Adolescents and young adults account for over one-third of all new global infections of HIV, representing a key population for prevention efforts. In sub-Saharan Africa, adolescent girls and young women (15-24) are more than twice as likely to become infected with HIV compared to their male counterparts and contribute nearly 25% of all new HIV infections in the region. Antiretroviral pre-exposure prophylaxis, or PrEP, has been found in clinical trials to be an efficacious biomedical HIV prevention strategy that holds enormous potential to reduce HIV acquisition in key populations globally. Among young African women, however, a range of adherence outcomes have been observed, with low adherence compromising PrEP efficacy in several trails. Further, adolescents under 18 years of age remain inadequately represented in PrEP research, posing a significant challenge for understanding how to deliver PrEP to young people with a focus on maximizing adherence. Research is needed to identify specific considerations relevant to the implementation of PrEP among adolescent girls and young women in generalized HIV epidemic settings. The objective of this study is to examine how disclosure of PrEP use and depression impact continuation of and adherence to daily oral PrEP among adolescent girls and young women in Eastern and Southern Africa. The specific aims of this research are to: (1) examine the association between disclosure of PrEP use to parents, partners, and peers and PrEP continuation and adherence; and (2) determine if depression is associated with PrEP continuation and adherence. This study will utilize longitudinal cohort data from EMPOWER, a multi-site prospective PrEP implementation study conducted among young women at substantial risk for HIV infection in Johannesburg, South Africa and Mwanza, Tanzania. A sample of 418 adolescent girls and young women (16-24 years of age) from the EMPOWER cohort who initiated daily oral PrEP will be included in this investigation. Participants were followed quarterly for up to 15 months. Adherence to PrEP, the primary study outcome, will be measured retrospectively using drug levels in dried blood spot samples for a biologic assessment of PrEP use. This investigation can help inform PrEP implementation strategies among adolescent girls and young women by providing insight into the social and psychological dynamics that facilitate adherence. To support the successful execution of this research project and promote the applicant’s growth into an independent investigator, additional training during the fellowship period will be sought to enhance the applicant’s collaborative research network, quantitative analysis skills, and interdisciplinary subject matter knowledge. Together, this proposed research and training plan will lay the foundation for the applicant’s future career as an independently funded epidemiologist focused on global health and HIV prevention research.