A Structural Intervention for Most-At-Risk Populations in Mombasa, Kenya

针对肯尼亚蒙巴萨高危人群的结构性干预

• 批准号: 8658578
• 负责人: Joanne Ellen Mantell
• 金额: $ 65.36万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8658578
• 关键词: AIDS prevention; Accounting; Acquired Immunodeficiency Syndrome; Address; Africa; Africa South of the Sahara; Alcohol consumption; Alcohols; Ally; Area; Behavioral; Belief; Biological; Biological Markers; Case Manager; Client; Collaborations; Complex; Counseling; Cross-Sectional Studies; Data; Data Collection; Development; Education; Environment; Evaluation; Feasibility Studies; Female; Female Condoms; Future; Grant; Guidelines; HIV; HIV Infections; HIV risk; HIV/STD; Heterosexuals; Human immunodeficiency virus test; Individual; Intervention; Interview; Kenya; Link; Lubricants; Male Condoms; Measures; Methods; Participant; Patient Self-Report; Phase; Play; Populations at Risk; Prevalence; Prevention; Prevention Research; Prevention strategy; Preventive Intervention; Prisons; Procedures; Process Measure; Province; Qualitative Methods; Randomized; Recruitment Activity; Research; Research Project Grants; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Role; Sample Size; Science; Sexual Partners; Sexual Transmission; Site; Testing; Text; Transact; Work; base; cohort; condoms; design; high risk sexual behavior; informant; male; male sex worker; meetings; men who have sex with men; multilevel analysis; peer; post intervention; public health priorities; public health relevance; response; sex; sex risk; social; theories; transmission process

DESCRIPTION (provided by applicant): Female sex workers (FSWs) are at heightened risk for acquiring and transmitting HIV infection because of biological, behavioral and structural risk factors. In Kenya's Coast Province, the site of the proposed study and a hotspot for sex work, sex workers and clients accounted for 18.2% of new HIV infections, and men who have sex with men, including those who sell sex (MSW), for 20.5%. These data suggest that most current HIV prevention initiatives for these most-at-risk populations are inadequate. Few HIV prevention interventions have addressed comprehensively the intersecting social worlds of sex workers, clients, and settings in which sex is transacted. The majority of venue-based interventions for SWs worldwide have been implemented in brothels, or other sex work-specific establishments. Few have been conducted in bars/clubs, have targeted clients and MSWs, and have been conducted in Africa. Therefore, we plan to develop and pilot a multi-level intervention in nightclubs/bars in Mombasa, Kenya. We will use a randomized controlled design to evaluate intervention feasibility via independent pre- and post-intervention cross-sectional surveys with 160 FSWs, 160 MSWs and 160 male clients, and cohorts of 80 FSWs, 80 MSWs and 80 male clients recruited from 2 intervention and 2 control bars/nightclubs venues. The specific aims of this mixed-methods study are to (1) understand the socio-cultural context of risk behavior, beliefs/understandings of HIV and risk; barriers to and facilitators of risk-reduction; and responses to intervention messages among 25 male clients, 25 MSWs, and 25 FSWs via formative research to inform intervention content to be refined in Phase 2 (Phase 1); (2) in collaboration with local key informants, design a multi-level risk-reduction intervention tailored o the local context and informed by theory and our prior work, that includes peer-delivered individual and group education, distribution of male and female condoms and lubricants, "street theater" presentations, on-site "moonlight" HIV testing and counseling and STI care, and manager meetings in Mombasa bars and nightclubs (Phase 2); (3) test the intervention package developed in Phase 2 for feasibility, acceptability, as well as participant level of exposure and intervention contamination at control sites via process measures; and (4) test the feasibility of an intervention evaluation design (in Phase 3) to be used in a future study, by: (a) developing and evaluating recruitment and data collection procedures; (b) determining the usefulness of potential biomarkers of condom use; (c) assessing retention of a longitudinal cohort of FSW, MSW, and clients; (d) developing power and sample size calculations to inform feasibility for a future venue-based combination prevention trial; and (e) comparing different ways of measuring condom use: self-report via interview and text messaging, and biomarkers among SWs so as to determine most relevant measures for use in a larger trial.

描述（由申请人提供）：由于生物，行为和结构性危险因素，女性性工作者（FSWS）的获取和传播HIV感染的风险更高。在肯尼亚海岸省，拟议的研究的地点和性工作的热点，性工作者和客户占新艾滋病毒感染的18.2％，与男性发生性关系的男性，包括卖出性行为（MSW）的男性，占20.5％。这些数据表明，对于这些最危险的人群，大多数当前的艾滋病毒预防计划不足。很少有预防艾滋病毒的干预措施全面解决了与性工作者，客户和环境的社交世界相交的，这些社会世界与性交的交易。全球SWS的大多数基于场地的干预措施已在妓院或其他特定于性工作的机构中实施。酒吧/俱乐部很少有人针对客户和MSW，并且在非洲进行了。因此，我们计划在肯尼亚的蒙巴萨开发和试行对夜总会/酒吧进行多层干预。我们将使用随机对照设计来评估通过独立干预前后的横截面调查的干预可行性，该调查具有160 fsws，160 MSW和160个男性客户，以及80 FSW，80 MSW和80个男性客户的同伙，从2个干预和2个干预栏和2个对照杆/夜总会场所招募。 这项混合方法研究的具体目的是（1）了解风险行为，艾滋病毒和风险的信念/理解的社会文化背景；降低风险的障碍和促进者；并通过形成性研究对25个男性客户，25 MSW和25 fsw的干预信息的响应，以告知干预内容，以在第2阶段（第1阶段）中进行完善； (2) in collaboration with local key informants, design a multi-level risk-reduction intervention tailored o the local context and informed by theory and our prior work, that includes peer-delivered individual and group education, distribution of male and female condoms and lubricants, "street theater" presentations, on-site "moonlight" HIV testing and counseling and STI care, and manager meetings in Mombasa bars and nightclubs (Phase 2); （3）测试在第2阶段开发的干预软件包，以确保可行性，可接受性以及通过过程指标对控制地点的暴露和干预污染的参与者水平； （4）测试将在未来研究中使用的干预评估设计（在第3阶段）的可行性，作者：（a）开发和评估招聘和数据收集程序； （b）确定使用避孕套的潜在生物标志物的有用性； （c）评估FSW，MSW和客户的纵向队列的保留； （d）开发功率和样本量计算，以告知对未来基于场地的预防试验的可行性； （e）比较避孕套使用的不同方法：通过访谈和文本消息传递自我报告，以及SWS之间的生物标志物，以确定在较大试验中使用的最相关的措施。