Prison PrEP Values Adherence and Implementation in Lusaka (PrEVAIL)

卢萨卡监狱 PrEP 重视遵守和实施 (PrEVAIL)

• 批准号: 10401510
• 负责人: Cassidy W. Claassen
• 金额: $ 19.72万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-04 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10401510
• 关键词: AIDS prevention; Address; Adherence; Africa; Africa South of the Sahara; Communities; Country; Criminal Justice; Data; Development; Eligibility Determination; Enrollment; Epidemic; Funding; Future; Goals; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health; Human immunodeficiency virus test; Imprisonment; Incidence; Intervention; Interview; Justice; Knowledge; Left; Measures; Methods; Motivation; North America; Oral; Participant; Patient Self-Report; Pattern; Persons; Population; Prevalence; Prevention; Prevention strategy; Prisons; Qualitative Research; Questionnaires; Research; Research Methodology; Risk; Risk Behaviors; Risk Factors; Sampling; Seasons; Service delivery model; Social support; System; Tenofovir; Testing; Time; United States National Institutes of Health; Urine; Visit; Work; Zambia; cohort; emtricitabine; epidemic response; innovation; insight; interest; low and middle-income countries; meetings; member; men; novel; point of care; pre-exposure prophylaxis; preference; prevention service; primary outcome; prospective; response; risk perception; secondary outcome; service delivery; substance use; theories; uptake

PROJECT SUMMARY Incarcerated people are one of the key populations at the center of the HIV epidemic in Zambia and sub-Saharan Africa (SSA) in general. The periods during and after incarceration likely represent times of significant HIV risk, yet little is known about HIV infection vulnerability during these times or how best to provide incarcerated people with HIV prevention services such as pre-exposure prophylaxis (PrEP) to reduce HIV risk. To address these knowledge gaps, we propose the Prison PrEP Values, Adherence, and Implementation in Lusaka (PreVAIL) study. Our scientific premise is that providing effective combination prevention to incarcerated and justice- involved populations requires understanding both temporal changes in their HIV risk and patterns of their PrEP uptake, adherence, and persistence. The long-term goal of this work is to optimize the timing and delivery of PrEP, as part of combination prevention, for justice-involved persons in Zambia. The objective of this R21 is to characterize PrEP uptake, adherence, and persistence, as well as HIV risk perceptions and behaviors, among justice-involved persons during incarceration and transition to the community. PreVAIL builds on a robust platform for corrections-health research and service delivery in Zambia. The TasP study (Co-PI: Herce) was the first to assess universal test and treat for HIV for incarcerated people in SSA, the NIH-funded CONTINUUM study (PI: Herce) was one of the first studies to follow incarcerated people after release in SSA, and the CDC/PEPFAR-funded CIRKUITS project (PI: Claassen, Co-PI: Herce) is conducting one of the first demonstrations of PrEP for justice-involved people in SSA. In Aim 1 we will assess PrEP uptake, adherence, and persistence, as well as HIV risk factors and perception of HIV risk, among justice-involved people during incarceration and post-release. We will prospectively enroll a cohort of 800 HIV-negative and PrEP-eligible incarcerated people at prison entry and offer them oral PrEP. We will follow all cohort members for 12 months regardless of PrEP status, both during incarceration and following release. Primary outcomes include PrEP uptake, adherence, and persistence, as well as HIV status, HIV risk behaviors and risk perception. PrEP adherence will be assessed through self-report and a novel point-of-care urine tenofovir test. In Aim 2, we will use qualitative research methods to explore and understand barriers and facilitators of PrEP uptake, adherence, and persistence during incarceration and after release. We will purposively sample 40 participants from our cohort for theory-informed longitudinal in-depth interviews to understand multi- level barriers and facilitators to efficacious PrEP use, as well as PrEP method and service delivery preferences. This study will provide new insights into HIV risk for justice-involved people in Africa and quantify the magnitude of the gap in HIV prevention service continuity, leading to a future, efficacious PrEP differentiated service delivery model to support justice-involved people in Zambia during the period spanning incarceration and post-release.

项目摘要 被监禁的人是赞比亚和撒哈拉以南艾滋病毒流行中心的关键人群之一 非洲（SSA）一般。监禁期间和之后的时期可能代表了艾滋病毒的重大风险时间， 然而，对于这些时期的艾滋病毒感染脆弱性或如何最好地向被监禁的人提供的知识知之甚少 通过艾滋病毒预防服务，例如暴露前预防（PREP），以降低艾滋病毒风险。解决这些 知识差距，我们建议在卢萨卡（Prevail）提出监狱准备价值，遵守和实施 学习。我们的科学前提是，为被监禁和正义提供有效的预防组合 - 涉及的人群需要了解其艾滋病毒风险和准备模式的时间变化 吸收，依从性和持久性。这项工作的长期目标是优化 作为预防合并的一部分，为赞比亚的司法人员进行准备。 R21的目的是 表征预备，依从性和持久性以及艾滋病毒风险感知和行为 在监禁和过渡到社区期间，司法人员涉及的人。 Prepail在一个强大的平台上建立在赞比亚的矫正健康研究和服务交付的基础上。 tasp 研究（Co-Pi：Herce）是第一个评估SSA被监禁的人普遍测试和治疗HIV的人， NIH资助的连续研究（PI：HERCE）是最早关注被监禁的人的研究之一 在SSA中发布，CDC/PEPFAR资助的Cirkuits项目（PI：Claassen，Co-Pi：Herce）正在进行 SSA中针对正义人士的人的第一批示威活动之一。 在AIM 1中，我们将评估预先吸收，依从性和持久性，以及HIV风险因素和 在监禁和释放后，对司法诉讼的人中对艾滋病毒风险的看法。我们将 前瞻性地注册了800名HIV阴性和预先符合条件的被监禁的人入场并提供 他们口头准备。我们将关注所有队列成员12个月，而不管状态如何 监禁和随后发布。主要结果包括准备，依从性和持久性， 以及艾滋病毒状况，艾滋病毒风险行为和风险感知。准备依从性将通过自我报告评估 以及一种新颖的护理尿液替诺福韦测试。 在AIM 2中，我们将使用定性研究方法来探索和了解 在监禁期间和释放后的预先吸收，依从性和持久性。我们将有目的地 样本40位来自我们的理论知识纵向深入访谈的参与者，以了解多种 为有效的预备使用以及准备方法和服务交付偏好的水平障碍和促进者。 这项研究将为非洲官方诉讼的人提供有关艾滋病毒风险的新见解，并量化 艾滋病毒预防服务连续性的差距，导致未来，有效的差异化服务交付 在涵盖监禁和释放后的时期，为赞比亚提供官方诉讼的人的模型。