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

基本信息

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
项目类别：
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

项目摘要

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?

项目概要我们的首要目标是遏制艾滋病毒流行及其对撒哈拉以南地区年轻人的负面影响非洲（SSA）通过提高多层次组合艾滋病毒的吸收、保留和依从性 AGYW 和男性伴侣的预防措施南非估计有 630 万艾滋病毒感染者 – 尽管拥有世界上最大的艾滋病毒治疗计划，但艾滋病毒发病率仍然是世界上最高的。少女和年轻女性（15-24 岁的 AGYW）仍然非常高。 HIV 联合预防方面的重大创新，例如普遍检测和治疗 (UTT) 和暴露前预防（PrEP），这远远超出了提供它们的能力，控制艾滋病毒的流行是一项艰巨的任务。迫切需要显着提高 AGYW 和男性伴侣对艾滋病毒预防的认识和保留，同时测试呈阳性的 UTT 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性。夸祖鲁-纳塔尔省贫困农村高流行地区的活动：推出八个新的以青年为重点的多 PEPFAR 的坚定、有韧性、最先进的赋权、无艾滋病、指导和安全 (DREAMS) 计划人口和健康监测，其中有关个体艾滋病毒生物标志物、性行为、艾滋病毒的数据我们将把预防和抗逆转录病毒治疗与公共部门的艾滋病毒临床记录和其他护理联系起来。通过三个相互关联的目标来实现这一目标：具体目标 1：量化多个层面的社会动态相互作用来预测 DREAMS 成分的吸收方法：我们将使用群体的分层分析。监测数据，以评估社区、家庭和人际层面的暴露如何预测吸收每项干预措施以及两个综合结果衡量标准：1) 接触社区层面的梦想干预措施，2) 接受个人层面的艾滋病毒护理和预防具体目标 2：阐明如何进行。个人生命历程的转变和接触梦想会影响对艾滋病毒护理的保留和依从性预防方法：我们将利用人口监测数据的生存分析和深入分析。定性访谈，以评估特定生命历程事件如何影响艾滋病毒预防和护理级联轨迹以及社区层面的 DREAMS 暴露如何调节生命历程转变的影响具体目标 3：确定家庭和同伴网络策略是否有所改善。年轻人接受并坚持综合预防干预措施方法：我们将与年轻人合作。青年适应现有的社区和同伴支持模式，以制定目标 1 为指导的干预措施 2. 我们将试验这种方法在改善 AGYW 和男性同龄人方面的可接受性和可行性我们的多学科团队包括艾滋病毒流行病学家、艾滋病毒流行病学家、艾滋病毒护理和预防的接受者和保留者。来自非洲卫生署的生物统计学家、社会科学家、心理学家和干预开发专业知识研究所、伦敦大学学院南安普顿分校和伦敦卫生与热带学院展望未来，这将为 NIH 优先领域提供答案：可以利用同伴、家庭和社区级网络充分利用多层次艾滋病毒降低死亡率和艾滋病毒发病率的潜力农村地区青少年的预防措施？