Multilevel Comprehensive HIV Prevention for South African Adolescent Girls and Young Women

南非少女和年轻妇女的多层次综合艾滋病毒预防

基本信息

批准号：
10466893
负责人：
GERI R DONENBERG
金额：
$ 87.12万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10466893
关键词：
18 year old 19 year old AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adolescent Adopted Africa Africa South of the Sahara Alcohol consumption Area Behavior Biomedical Technology Caregivers Caring Continuity of Patient Care Cost Control Counseling Data Decision Making Discrimination Drug usage Economics Educational Curriculum Effectiveness Epidemic Epidemiology Evaluation Evidence based intervention Failure Family Female Female Adolescents Foundations Generations Goals Government HIV HIV Infections HIV risk HIV/STD Health Health Promotion Human immunodeficiency virus test Incidence Individual Infection Intervention Mediator of activation protein Mental disorders Methodology Modeling Outcome Phase Pilot Projects Politics Prevalence Prevention Prevention program Primary Prevention Process Public Health Reporting Research Resources Risk Risk Behaviors Safe Sex Science Services Sex Behavior Shapes Site South Africa South African Testing Time Woman Youth acceptability and feasibility age group arm base behavior change compare effectiveness condoms cost cost effectiveness cost-effectiveness evaluation data sharing design effectiveness evaluation experience follow-up girls high risk sexual behavior improved innovation male men metropolitan mortality multidisciplinary novel peer phase II trial pilot test pre-exposure prophylaxis prevent programs public health priorities role model sexual risk behavior sexual risk taking social culture social stigma social structure stem transmission process uptake young woman

18 year old 19 year old AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adolescent Adopted Africa Africa South of the Sahara Alcohol consumption Area Behavior Biomedical Technology Caregivers Caring Continuity of Patient Care Cost Control Counseling Data Decision Making Discrimination Drug usage Economics Educational Curriculum Effectiveness Epidemic Epidemiology Evaluation Evidence based intervention Failure Family Female Female Adolescents Foundations Generations Goals Government HIV HIV Infections HIV risk HIV/STD Health Health Promotion Human immunodeficiency virus test Incidence Individual Infection Intervention Mediator of activation protein Mental disorders Methodology Modeling Outcome Phase Pilot Projects Politics Prevalence Prevention Prevention program Primary Prevention Process Public Health Reporting Research Resources Risk Risk Behaviors Safe Sex Science Services Sex Behavior Shapes Site South Africa South African Testing Time Woman Youth acceptability and feasibility age group arm base behavior change compare effectiveness condoms cost cost effectiveness cost-effectiveness evaluation data sharing design effectiveness evaluation experience follow-up girls high risk sexual behavior improved innovation male men metropolitan mortality multidisciplinary novel peer phase II trial pilot test pre-exposure prophylaxis prevent programs public health priorities role model sexual risk behavior sexual risk taking social culture social stigma social structure stem transmission process uptake young woman

展开

项目摘要

ABSTRACT Reducing new HIV and STI infections among South African (SA) adolescent girls and young women (AGYW) is global public health priority.1 SA has world's largest HIV epidemic,2,3 and SA AGYW acquire HIV at twice the rate of and seroconvert on average 5 – 7 years earlier than male peers.3 As new infections continue to outpace access to and availability of PrEP and ART, primary prevention remains the most viable strategy to stem new transmissions.1,4,5 SA efforts to prevent HIV transmission in youth focus mostly on individual-level behavior change,6-8 but AGYW's persistent HIV disparities are explained by broad social and structural inequities that shape and constrain HIV-risk behaviors.9-14 Comprehensive HIV prevention packages that are integrated, synergistic, and tailored to the local epidemiology and cultural context are likely to achieve and sustain maximum reductions in HIV-risk.15-22 Female caregivers (FC) are an untapped resource in the HIV prevention toolbox23,24 and offer a novel opportunity to strengthen AGYW prevention efforts. AGYW may also be change agents for their FC who want to be positive role models for AGYW, and thus, adopt HIV prevention behaviors, including HTC and PrEP. Guided by an ecological framework, our highly experienced multidisciplinary team will adapt (phase 1/UG3) and evaluate the effectiveness and cost-effectiveness of (phase 2/UH3) IMARA, a multilevel, innovative, family-based HIV prevention program that targets individual, social, and structural drivers of risk to decrease HIV and STI incident infections, reduce risky sexual behavior, and increase HTC and PrEP uptake (where appropriate) in AGYW and FC. IMARA demonstrated a 45% reduction in incident STI at 12-month follow-up among black 14-18 year-old girls in the US, and increased HIV testing in FC. Pilot data with 71 AGYW and FC at the Desmond Tutu HIV Foundation (DTHF; study site) confirm feasibility and acceptability of IMARA for the South African context. This study will be integrated into the adolescent-friendly services at DTHF in the Western Cape metropolitan area facilitating sustainability if effective. Using the ADAPT-ITT model, we will systematically tailor IMARA for the SA context and then conduct a 2-arm RCT with 300 15-19 year-old AGYW and FC. FC and AGYW will complete baseline, 6-, and 12-month assessments, including testing for 3 STI. We will offer HTC and PrEP at each assessment and track uptake and linkage to care. AGYW and FC who test positive for a STI and/or HIV will receive free treatment at DTHF. We will collect data to determine the costs of IMARA. Analyses will compare AGYW and FC across the intervention and control programs on sexual risk taking, STI and HIV incidence, PrEP and HTC uptake, and theoretical mediators. The study answers an urgent need to evaluate the effectiveness and cost-effectiveness of combination HIV prevention packages for AGYW to achieve an AIDS-free generation.

抽象的减少南非（SA）青少年女孩和年轻女性的新艾滋病毒和性传播感染（AGYW）是全球公共卫生优先事项。1SA拥有世界上最大的HIV流行，2,3和SA Agyw获得艾滋病毒的平均比男同龄人早5至7年的速度和血清复合率的两倍。3 感染继续向外访问和可用性和艺术的可用性，主要预防仍然是最可行的策略来阻止新的传播。1,4,5SA为防止青年关注的艾滋病毒传播而努力主要是关于个人层面的行为改变，6-8，但AGYW的持续性HIV差异是由塑造和限制艾滋病毒风险行为的广泛的社会和结构不平等。9-14综合艾滋病毒针对本地流行病学和文化的综合，协同和量身定制的预防包环境可能会实现并维持艾滋病毒风险的最大减少。15-22女照顾者（FC）是艾滋病毒预防工具箱中未开发的资源23,24，并提供了增强AGYW的新型机会预防努力。 AGYW也可能是希望成为积极榜样的FC的变革推动者 AGYW，因此采用了包括HTC和PREP在内的HIV预防行为。以生态学为指导框架，我们经验丰富的多学科团队将适应（第1阶段/UG3），并评估（第2阶段/UH3）Imara的有效性和成本效益，一种多级，创新的，基于家庭的艾滋病毒针对个人，社会和结构性驱动因素的预防计划，以减少艾滋病毒和STI 事件感染，减少风险的性行为，增加HTC和PREP吸收（在适当的情况下）在Agyw和FC中。 Imara在12个月的随访中显示出45％的事件STI降低在美国，黑人14-18岁的女孩，并增加了FC的艾滋病毒测试。带有71 AGYW和FC的飞行员数据 Desmond Tutu HIV基金会（DTHF；研究地点）证实了Imara的可行性和可接受性南非的背景。这项研究将集成到DTHF的青少年友好服务中西开普大都市地区促进可持续性，如果有效。使用Adapt-Itt模型，我们将系统地为SA上下文量身定制iMara，然后与300 15-19岁的2臂RCT进行 AGYW和FC。 FC和AGYW将完成基线，6个月和12个月的评估，包括测试对于3 sti。我们将在每次评估中提供HTC和准备，并跟踪关怀的吸收和联系。 Agyw 对STI和/或HIV呈阳性的FC将在DTHF获得免费治疗。我们将收集数据确定Imara的成本。分析将在干预和控制中比较AGYW和FC 有关性风险，性传播感染和艾滋病毒事件，PREP和HTC吸收以及理论调解人的计划。该研究回答了评估组合的有效性和成本效益的迫切需求 AGYW预防艾滋病毒预防包，以实现无艾滋病的生成。