ZAIMARA: Zambian Informed Motivated Aware and Responsible Adolescents and Adults

项目摘要 赞比亚正在努力实现为少女和年轻妇女(AGYW)设定的95-95-95目标。艾滋病病毒 15-19岁的流行率为3.3%，AGYW感染艾滋病毒的可能性是男性同龄人的4倍 (8.6%对2.1%)。2010-2020年，AGYW的艾滋病毒发病率上升，而所有其他群体的艾滋病毒发病率都在下降，但艾滋病毒 检测率低(45.4%)，71.2%的人不知道自己的艾滋病毒状况。拟议的混合试验将评估 疾病预防控制中心“最佳证据”干预的有效性和实施，知情、有动机、有意识和 《负责任的青少年与成人》(Imara)，最近改编自南非(Imara-SA)，前景看好 对AGYW性传播感染发病率、性风险、PrEP摄取和心理健康的影响。在探索的指引下， 本研究的准备、实施、可持续框架和实施研究逻辑模型 解决循证方案在低资源环境下可持续性差的一个关键驱动因素-- 因精神困扰和工作满意度低而导致的卫生人力--通过评估心理健康的影响 对交付Imara的同行领导人进行筛选和推荐。在初步焦点小组的基础上建立关键 赞比亚的利益攸关方，这项研究的目的是：(1)为赞比亚背景制作Tailor Imara-SA ZAIMARA；(2) ZAIMARA与一般健康促进计划对6岁时AGYW HIV检测接受率的影响比较 月(主要临床结果)、发生性传播感染(包括艾滋病毒)、性行为和PrEP摄取(次要) 在基线、6个月、12个月、18个月和24个月)。(3)研究精神健康筛查的影响和 推荐人与同级领导工作保留率的一般签到。(4)使用以下工具评估ZAIMARA实施成果 混合的方法和关键的线人采访。传染病研究中心之间的伙伴关系 赞比亚(CIDRZ)和美国传播与实施科学中心(CDIS)将 确保在卢萨卡省五个地理位置不同的社区完成研究所需的专业知识， 赞比亚艾滋病毒感染率最高的区域，同时建设实施科学研究的能力。 这是一项有理论基础、假设驱动的混合试验，解决了艾滋病毒预防中的关键差距。 赞比亚AGYW的长期目标是维持有效的方案，以减少艾滋病毒/性传播感染。

Project Abstract Zambia is struggling to meet the 95-95-95 targets for adolescent girls and young women (AGYW). HIV prevalence in 15-19 year-olds is 3.3%, and AGYW are 4 times more likely to acquire HIV than their male peers (8.6% vs. 2.1%). HIV incidence increased in AGYW from 2010-2020 while decreasing in all other groups, yet HIV testing rates are low (45.4%), and 71.2% do not know their HIV status. The proposed hybrid trial will evaluate the effectiveness and implementation of a CDC “best-evidence” intervention, Informed Motivated Aware and Responsible Adolescents and Adults (IMARA), recently adapted for South Africa (IMARA-SA) with promising effects on AGYW STI incidence, sexual risk taking, PrEP uptake, and mental health. Guided by the Exploration, Preparation, Implementation, Sustainment framework and an Implementation Research Logic Model, this study addresses a key driver of poor sustainability of evidence-based programs in low-resource settings - attrition in health workforce due to mental distress and low job satisfaction – by evaluating the impact of mental health screening and referral on peer leaders delivering IMARA. Building on preliminary focus groups with key stakeholders in Zambia, the study aims to: (1) Tailor IMARA-SA for the Zambian context to produce ZAIMARA; (2) Compare the effects of ZAIMARA vs. a general health promotion program on AGYW HIV testing uptake at 6 months (primary clinical outcome), incident STIs (including HIV), sexual behavior, and PrEP uptake (secondary clinical outcomes) at baseline, 6-, 12-, 18-, and 24 months. (3) Examine the impact of mental health screening and referral vs. a general check-in on peer leader job retention. (4) Evaluate ZAIMARA implementation outcomes using mixed methods and key informant interviews. The partnership between the Centre for Infectious Disease Research in Zambia (CIDRZ) and the Center for Dissemination and Implementation Science (CDIS) in the United States will ensure the expertise needed to complete the study in five geographically distinct communities in Lusaka Province, the region with the highest HIV prevalence in Zambia, while building capacity for implementation science research. This is a theoretically-grounded, hypothesis-driven hybrid-trial that addresses critical gaps in the HIV prevention continuum for Zambian AGYW, with a long-term goal to sustain effective programs that reduce HIV/STI infections.