Community-based combination HIV prevention in Tanzanian women at heightened risk

对坦桑尼亚高危妇女进行社区艾滋病毒综合预防

• 批准号: 8896067
• 负责人: DEANNA L KERRIGAN
• 金额: $ 56.44万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-25 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8896067
• 关键词: AIDS prevention; Address; Adherence; Adult; Affect; Africa South of the Sahara; Anti-Retroviral Agents; Area; Asia; Attention; Behavioral; Caring; Communities; Counseling; Country; Data Collection; Discrimination; Drops; Education; Effectiveness; Ensure; Environment; Epidemic; Face; Female; Gender Role; Goals; HIV; HIV Infections; HIV risk; Health; Health Services Accessibility; Human immunodeficiency virus test; Incidence; Infection; Intervention; Intervention Studies; Latin America; Life; Maps; Mediating; Meta-Analysis; Methods; Modeling; Outcome; Outcome Study; Pathway interactions; Phase; Play; Population; Positioning Attribute; Prevalence; Prevention; Prevention approach; Preventive Intervention; Provider; Public Health; Randomized; Randomized Controlled Trials; Research; Research Design; Research Infrastructure; Risk; Risk Reduction; Role; Safety; Services; Sex Behavior; Signal Transduction; Tanzania; Testing; Text; Time; Treatment Efficacy; Update; Violence; Viral Load result; Woman; Work; arm; attributable mortality; base; burden of illness; clinical care; cohesion; cohort; condoms; demographics; design; empowerment; peer; phase II trial; phase III trial; public health relevance; response; sensitivity training; sex; social; social stigma; systematic review; theories; transmission process

DESCRIPTION (provided by applicant): Combination HIV prevention demonstrates significant promise in reducing burden of disease. To maximize its effectiveness combination prevention must be tailored to a given context and population. From the beginning of the global HIV epidemic, female sex workers (FSWs) have been found to be at heightened risk for infection. More recently the role that sex work plays in ongoing HIV transmission dynamics has been more clearly established in generalized epidemics, where previously limited attention was paid to the role of key populations. The greater vulnerability of FSWs is now widely understood to be associated with social and structural factors including the intense stigma, discrimination and violence they often face and the unsafe environments in which they live and work. These factors are known to limit both protective sexual behaviors and engagement in HIV testing, care and treatment services. Comprehensive, community-based HIV prevention approaches addressing the aforementioned social and structural vulnerabilities to HIV infection among FSWs have been shown to be effective in South Asia and in Latin America. However, in sub-Saharan Africa where the impact of HIV is the greatest, no systematic efforts to develop and evaluate the feasibility and effectiveness of community-based combination HIV prevention among FSWs has occurred. We propose to conduct a two-arm Phase II community randomized controlled trial of a community-based combination HIV prevention intervention among FSWs in Iringa, Tanzania. The model was developed on the basis of prior formative research and mapping and utilizes an ongoing research infrastructure. The combination package will include integrated biomedical, behavioral and structural components: (1) mobile HIV testing and risk reduction counseling; (2) service navigation to facilitate access to treatment and retention in care; (3) sensitivity trainin for HIV clinical care providers; (4) SMS text messages to promote adherence to care and ART; (5) venue-based peer education and condom distribution; and (6) a community drop- in-center to promote cohesion and collective action to reduce stigma and discrimination. We seek to establish base rates of key outcomes including HIV incidence and viral load suppression, examine the socio-structural and behavioral pathways of the intervention, assess feasibility, acceptability and safety, and document preliminary effectiveness. Should compelling indications of safety, feasibility, acceptability and initial effectiveness be found, study results will informthe first Phase III RCT of community-based combination HIV prevention among FSWs.

描述（由申请人提供）：预防艾滋病毒的组合在减轻疾病负担方面表现出了巨大的希望。为了最大程度地提高其有效性组合，必须根据给定的环境和人口量身定制。从全球艾滋病毒流行病开始时，就发现女性性工作者（FSW）处于感染风险较高。最近，性工作在正在进行的HIV传播动态中所起的作用在广义流行病中更清楚地确定，在此之前，对关键人群的作用提高了以前有限的关注。现在被广泛理解为FSW的更大脆弱性与社会和结构性因素有关，包括他们经常面临的强烈污名，歧视和暴力以及它们生活和工作的不安全环境。众所周知，这些因素限制了保护性行为和参与HIV测试，护理和治疗服务。综合的，基于社区的艾滋病毒预防方法涉及上述FSW中对艾滋病毒感染的社会和结构性脆弱性，在南亚和拉丁美洲有效。但是，在撒哈拉以南非洲，艾滋病毒的影响是最大的，没有系统的努力来发展和评估FSW中基于社区组合的艾滋病毒预防的可行性和有效性。我们建议在坦桑尼亚Iringa的FSW中对基于社区的HIV预防干预措施进行两臂II期社区随机对照试验。该模型是根据先前的形成性研究和映射开发的，并利用了正在进行的研究基础设施。组合包将包括综合的生物医学，行为和结构组件：（1）移动艾滋病毒测试和降低风险咨询； （2）服务导航，以方便获得治疗和保留率； （3）艾滋病毒临床护理提供者的敏感性培训； （4）SMS短信以促进遵守护理和艺术； （5）基于场地的同伴教育和避孕套分配； （6）一个社区中心的中心，以促进凝聚力和集体行动，以减少污名和歧视。我们试图建立关键结果的基本速率，包括艾滋病毒发病率和病毒负荷抑制，检查干预措施的社会结构和行为途径，评估可行性，可接受性和安全性，并记录初步有效性。如果发现安全性，可行性，可接受性和初始有效性的令人信服的指示，研究结果将为FSW中基于社区的组合艾滋病毒预防的第一阶段RCT提供信息。