Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women

最大限度地提高青春期女孩和年轻女性的艾滋病毒预防、感染率和保留率

• 批准号: 9761594
• 负责人: Maryam Shahmanesh
• 金额: $ 49.04万
• 依托单位: KWAZULU-NATAL RESEARCH INSTITUTE TB-HIV
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-18 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9761594
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Adolescence; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Area; Attitude; Behavior Therapy; Biological Markers; Caring; Clinical; Communities; Contraceptive methods; Data; Epidemic; Epidemiologist; Event; Exposure to; Family; Female Adolescents; Financial cost; Gender; Goals; HIV; Health; Health care facility; Home environment; Household; Human immunodeficiency virus test; Hygiene; Incidence; Individual; Interdisciplinary Study; Intervention; Interview; Life Cycle Stages; Life Expectancy; Link; London; Male Circumcision; Medical; Mentors; Modeling; Outcome Measure; Paper; Population; Population Analysis; Population Surveillance; Prevention; Prevention program; Prevention therapy; Preventive Intervention; Provider; Psychologist; Public Sector; Records; Research; Research Institute; Risk; Risk Behaviors; Rural; Schools; Science; Scientist; Services; Sex Behavior; Site; South Africa; Survival Analysis; Testing; Time; Tropical Medicine; United States National Institutes of Health; Universities; Work; Youth; adaptive intervention; adolescent HIV prevention; antiretroviral therapy; college; condoms; empowered; family caregiving; family support; gender-based violence; high risk; improved; innovation; male; migration; mortality; multidisciplinary; novel; peer; peer networks; peer support; population health; pre-exposure prophylaxis; programs; prospective; response; rural South Africa; rural setting; scale up; social; social stigma; success; surveillance data; therapy design; therapy development; treatment program; uptake; young woman

Project Summary Our overarching goal is to arrest the HIV epidemic and its negative impact on young people in sub Saharan African (SSA) through improving the uptake, retention and adherence of multi-level combination HIV prevention by AGYW and male partners. South Africa has an estimated 6.3 million people living with HIV – the highest in the world. Despite having the largest HIV treatment program in the world, HIV incidence in Adolescent Girls and Young Women (AGYW aged 15-24) remains extremely high. Whilst there have been significant innovations in combination HIV prevention, e.g. universal test and treat (UTT) and Pre-exposure prophylaxis (PrEP), this has far outpaced the ability to deliver them. To control the HIV epidemic here is an urgent to significantly improve uptake and retention of HIV prevention by AGYW and male partners, alongside UTT of those testing positive. In this project we have a unique opportunity to leverage a key time-sensitive events in a poor and rural hyperendemic area of KwaZulu-Natal: The roll out of eight new youth-focused multi- level HIV prevention interventions for AGYW and their male partners by PEPFAR’s Determined, Resilient, Empowered, AIDS free, Mentored, and Safe (DREAMS) program in the context of a state of the art demographic and health surveillance, where data on individual HIV biomarkers, sexual behaviors, HIV prevention and ART exposure are linked to public-sector clinical records for HIV and other care. We will achieve this through three interlinked aims: Specific aim 1: Quantify how multiple levels of social dynamics interact to predict uptake of DREAMS components. Approach: We will use hierarchical analysis of population surveillance data to evaluate how community, household and interpersonal-level exposures predict uptake of each intervention, and two composite outcome measures: 1) Exposure to community-level DREAMS interventions, 2) uptake of the individual-level HIV care and prevention. Specific aim 2: Elucidate how individuals’ life-course transitions and exposure to DREAMS affect retention and adherence to HIV care and prevention. Approach: We will use both survival analysis of the population surveillance data and in-depth qualitative interviews to evaluate how specific life-course events affect HIV prevention and care cascade trajectories and how community-level DREAMS exposures moderate the impact of life-course transitions on adherence and retention. Specific aim 3: Ascertain whether family- and peer-network strategies improve uptake and adherence to combination prevention interventions by young people. Approach: we will work with youth to adapt existing models of community and peer-support to develop an intervention informed by aims 1 and 2. We will pilot the acceptability and feasibility of this approach on improving AGYW and male peers uptake and retention of HIV care and prevention. Our multidisciplinary team includes HIV epidemiologists, a biostatistician, social scientists, psychologist and intervention development expertise from the Africa Health Research Institute, University College London, Southampton and the London School of Hygiene and Tropical Medicine. Moving forward, this will provide answers to an NIH priority area: Can using peer, family and community-level networks harness the full mortality and HIV incidence reducing potential of multi-level HIV prevention for adolescents and young people in rural SSA?

项目摘要 我们的总体目标是逮捕艾滋病毒的流行及其对撒哈拉以南年轻人的负面影响 非洲（SSA）通过改善多层次组合艾滋病毒的摄取，保留和遵守 AGYW和男性伴侣的预防。南非估计有630万艾滋病毒的人 - 世界上最高的。尽管世界上最大的艾滋病毒治疗计划，但艾滋病毒事件 青春期女孩和年轻女性（15-24岁）仍然很高。而有 联合艾滋病毒预防的重大创新，例如通用测试和治疗（UTT）和暴露前 预防（PREP），这已经超过了交付它们的能力。控制艾滋病毒流行是 迫切需要大大改善AGYW和男性伴侣对艾滋病毒预防的摄取和保留 那些测试阳性的人。在这个项目中，我们有一个独特的机会来利用关键的时间敏感 夸祖鲁 - 纳塔尔省贫穷而粗糙的高度高度地区的事件：八个新的以青少年为中心的新型多人 Pepfar坚定的，有韧性 在最新状态的背景下 人口统计和健康监测，有关单个艾滋病毒生物标志物，性行为，艾滋病毒的数据 预防和艺术暴露与艾滋病毒和其他护理的公共部门临床记录有关。我们将 通过三个相互联系的目标来实现这一目标：特定目标1：量化多个级别的社会动态 互动以预测梦想成分的吸收。方法：我们将使用人群的分层分析 监视数据，以评估社区，家庭和人际阶段的暴露如何预测吸收 每种干预措施和两种综合结果指标：1）接触社区级梦 干预措施，2）吸收个人级别的艾滋病毒护理和预防。特定目标2：阐明如何 个人的生命过程过渡和对梦的暴露会影响保留和遵守艾滋病毒护理和 预防。方法：我们将同时使用人口监视数据和深入的生存分析 定性访谈以评估特定的生活课程活动如何影响艾滋病毒预防和护理级联 轨迹以及社区水平的梦想如何暴露于生命过程的影响 依从性和保留。特定目标3：确定家庭和同伴网络策略是否有所改善 年轻人的吸收和遵守预防干预措施。方法：我们将与 年轻人适应社区现有模型和同伴支持的模型，以开发AIMS 1的干预措施1 和2。我们将尝试这种方法在改善AGYW和男同龄人方面的可接受性和可行性 吸收和保留艾滋病毒护理和预防。我们的多学科团队包括艾滋病毒流行病学家，一个 非洲健康的生物统计学家，社会科学家，心理学家和干预发展专业知识 伦敦大学学院研究所，南安普敦和伦敦卫生学院 药品。向前迈进，这将为NIH优先领域提供答案：可以使用同伴，家人和 社区级网络利用全部死亡率和艾滋病毒发病率降低了多级艾滋病毒的潜力 SSA农村地区的青少年和年轻人的预防？