Making women's options for HIV prevention in Tanzania accessible and joining implementation science capacity building (MWOTAJI)

摘要 撒哈拉以南非洲的少女和年轻妇女(AGYW；15-24岁)面临着不成比例的负担 艾滋病毒感染的可能性。虽然像暴露前预防(PrEP)这样高效的艾滋病毒预防是 全球艾滋病毒流行控制战略，AGYW对PrEP的认识较低，吸毒率和 即使是较低健康水平的系统也往往装备不足，无法克服众多的准入障碍 AGYW面临的问题，包括污名、有害规范和以诊所为基础的卫生服务的不便。 越来越多的人认识到，以社区为基础的药店有可能弥合艾滋病毒的差距 预防和减轻AGYW之间的准入障碍。因此，这项研究的目标是评估马尔基亚岛 KLabu(“皇后俱乐部”)在坦桑尼亚的实施战略，这是为AGYW设计的忠诚度计划，由AGYW设计 创建对青年友好的药店，AGYW可以在那里获得艾滋病毒预防以及性和生殖 保健(SRH)服务，与以设施为基础的护理有很强的联系。 基于我们的初步研究中有希望的数据，我们假设，一个受欢迎和安全的 通过Malkia KLabu实施模式的药房环境将吸引AGYW并促进吸收 预防预防接种计划、艾滋病毒自我检测(HIVST)和其他SRH服务，从而使AGYW能够避免艾滋病毒和 意外怀孕。我们设计了一个创新的、为期5年的实施科学研究，以扩展和 评估Malkia KLabu基于药房的PrEP和HIVST分娩的几种模式 在坦桑尼亚莱克区使用RE-AIM框架的研究地点。这项研究将通过以下方式得到加强 对当地研究人员和政策制定者进行实施科学培训，以优化马尔基亚克拉布并使其受益 未来的艾滋病毒预防战略。我们将首先进行类型3混合实施-有效性研究 Malkia KLabu在50家药店的四种基于药房的差异化PrEP交付模式，检查 在增加用户费用分担之前和之后的实施结果，这对现实世界至关重要 可持续性(目标1)。我们将研究马尔基亚克拉布交付模式在有效利用 在575名AGYW队列中准备，在750人的横断面家庭调查中达到该计划的范围 研究领域的AGYW；对约200个AGYW进行的药房退出调查将有助于描述药房的成功- 基于PrEP的服务产品(目标2)。实施科学证书和种子基金 毕业生将确保该项目具有持久的影响(目标3)。 在研究结束时，我们将确定马尔基亚克拉布最强大和最可持续的版本 以药房为基础的PrEP和HIVST向AGYW交付的实施战略，并启动了 实施科学培训方案，使当地主导的推广和适应惠及弱势群体 整个坦桑尼亚和该地区的AGYW。该项目是姆祖姆贝大学、健康与健康组织 繁荣的国家，坦桑尼亚卫生部和加州大学(旧金山和伯克利)。

SUMMARY Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face a disproportionate burden of HIV infection. Though highly effective HIV prevention like pre-exposure prophylaxis (PrEP) is central to the global strategy for HIV epidemic control, awareness of PrEP among AGYW is low, with uptake and continuation even lower—health systems are often ill equipped to overcome the numerous access barriers faced by AGYW, including stigma, harmful norms, and the inconveniences of clinic-based health services. There is growing recognition that community-based pharmacies have the potential to bridge gaps in HIV prevention and mitigate access barriers among AGYW. Thus, the goal of this study is to evaluate the Malkia Klabu (“Queen Club”) implementation strategy in Tanzania, a loyalty program designed for and by AGYW that creates youth-friendly pharmacies where AGYW can access HIV prevention and sexual and reproductive health (SRH) services, with strong linkages to facility-based care. Based on promising data from our pilot study, we hypothesize that the creation of a welcoming and safe pharmacy environment through the Malkia Klabu implementation model will attract AGYW and bolster uptake of PrEP, HIV self-testing (HIVST), and other SRH services, thereby empowering AGYW to avoid HIV and unintended pregnancy. We have designed an innovative, 5-year implementation science study to scale and evaluate several models of Malkia Klabu’s pharmacy-based approach for PrEP and HIVST delivery in five research sites in Lake Zone, Tanzania using the RE-AIM framework. This research will be enhanced by implementation science training of local researchers and policymakers to optimize Malkia Klabu and benefit future HIV prevention strategies. We will first conduct a Type 3 Hybrid Implementation-Effectiveness study of four pharmacy-based differentiated PrEP delivery models of Malkia Klabu in 50 pharmacies, examining implementation outcomes before and after the addition of user cost-sharing which is essential for real-world sustainability (Aim 1). We will examine the success of the Malkia Klabu delivery models on effective use of PrEP among a cohort of 575 AGYW, reach of the program in a cross-sectional household survey with 750 AGYW in study areas; pharmacy exit surveys with ~200 AGYW will help describe the success of pharmacy- based PrEP service offerings (Aim 2). A Certificate in Implementation Science coupled with seed grants for graduates will ensure the project has lasting impact (Aim 3). At the study’s conclusion, we will determine the strongest and most sustainable version of the Malkia Klabu implementation strategy for pharmacy-based PrEP and HIVST delivery to AGYW, and launched an implementation science training program to enable locally-led scaling and adaptation to reach vulnerable AGYW across Tanzania and the Region. The project is a collaboration between Mzumbe University, Health for a Prosperous Nation, the Tanzania Ministry of Health, and University of California (San Francisco & Berkeley).