Evaluation of the Implementation of PrEP Provision for Ugandan Fisherfolk

对乌干达渔民 PrEP 规定实施情况的评估

• 批准号: 9927177
• 负责人: Laura M Bogart
• 金额: $ 18.37万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9927177
• 关键词: AIDS prevention; Africa South of the Sahara; Ambulatory Care Facilities; Area; Awareness; Boat; Businesses; Caring; Characteristics; Clinic; Communities; Community Health Aides; Community Healthcare; Country; Data; Epidemic; Evaluation; Event; Family; Fisheries; Fishes; Funding; Future; Gender; General Population; Goals; Government; HIV; HIV Seronegativity; HIV Seropositivity; HIV antiretroviral; Health; Health Personnel; Health care facility; Healthcare; Home environment; Hour; Human immunodeficiency virus test; Hybrids; Incidence; Individual; Intervention; Interview; Island; Labor Forces; Laboratories; Medical Records; Methods; Modeling; Policies; Population; Populations at Risk; Prevalence; Prevention Guidelines; Prostitution; Protocols documentation; Public Health Schools; Qualitative Research; Research; Rivers; Schedule; Secure; Series; Site; Specific qualifier value; Structure; Subgroup; Tenofovir; Testing; Time; Uganda; United States National Institutes of Health; Universities; Vendor; Work; aged; antiretroviral therapy; base; community clinic; cost; emtricitabine; health care availability; high risk; meetings; migration; outreach; pill; pre-exposure prophylaxis; prevent; programs; sociodemographics; treatment comparison; treatment guidelines; treatment organization; uptake; working group; AIDS prevention; Africa South of the Sahara; Ambulatory Care Facilities; Area; Awareness; Boat; Businesses; Caring; Characteristics; Clinic; Communities; Community Health Aides; Community Healthcare; Country; Data; Epidemic; Evaluation; Event; Family; Fisheries; Fishes; Funding; Future; Gender; General Population; Goals; Government; HIV; HIV Seronegativity; HIV Seropositivity; HIV antiretroviral; Health; Health Personnel; Health care facility; Healthcare; Home environment; Hour; Human immunodeficiency virus test; Hybrids; Incidence; Individual; Intervention; Interview; Island; Labor Forces; Laboratories; Medical Records; Methods; Modeling; Policies; Population; Populations at Risk; Prevalence; Prevention Guidelines; Prostitution; Protocols documentation; Public Health Schools; Qualitative Research; Research; Rivers; Schedule; Secure; Series; Site; Specific qualifier value; Structure; Subgroup; Tenofovir; Testing; Time; Uganda; United States National Institutes of Health; Universities; Vendor; Work; aged; antiretroviral therapy; base; community clinic; cost; emtricitabine; health care availability; high risk; meetings; migration; outreach; pill; pre-exposure prophylaxis; prevent; programs; sociodemographics; treatment comparison; treatment guidelines; treatment organization; uptake; working group

PROJECT SUMMARY In Ugandan fisherfolk communities, HIV prevalence is an order of magnitude higher than in the Ugandan general population, and high HIV prevalence among fisherfolk helps to drive the general epidemic. In a prior R21 study, we demonstrated that bringing HIV testing to fisherfolk communities, where healthcare facilities are scarce, can identify a large number of high-risk HIV-negative fisherfolk. To have a significant impact on the HIV epidemic among fisherfolk, a key next step in this research program would be to offer pre-exposure prophylaxis (PrEP; a highly effective and safe daily pill containing tenofovir and emtricitabine to prevent HIV) to high-risk HIV-negative fisherfolk following HIV testing. Although the 2016 Ugandan HIV prevention and treatment guidelines recommend PrEP for HIV prevention in fisherfolk, there is currently no governmental support for PrEP implementation in fisherfolk communities. Pilot data are urgently needed to demonstrate to the Ugandan Ministry of Health that PrEP can be feasibly delivered to fisherfolk, in order to secure government support for PrEP for fisherfolk. The Specific Aims are: (1) To conduct formative qualitative research to examine barriers to and facilitators of PrEP uptake, and to obtain input on acceptable PrEP messaging and provision, for fisherfolk communities on Lake Victoria, Uganda; and (2) To conduct a mixed-methods analysis comparing the implementation of community-based vs. healthcare facility-based PrEP provision for fisherfolk communities on Lake Victoria, Uganda. For both PrEP interventions, we will conduct monthly HIV testing and PrEP and antiretroviral treatment provision events, using messages developed from the formative work to raise awareness about PrEP. PrEP will be offered to 100 fisherfolk in two Lake Victoria landing sites during testing events on specified days of the month: In one site, PrEP will be distributed in a nearby healthcare facility during monthly events, and in the other site, PrEP will be distributed in a temporary community space. Among those who are non-adherent (based on refill data), PrEP provision will be supplemented via PrEP delivery by community health workers or at community PrEP pick-up points, based on strategies elicited in the formative work. To evaluate implementation, we will conduct semi-structured interviews with healthcare providers and fisherfolk who do and do not decide to initiate PrEP, and obtain medical records data to compare the proportion of fisherfolk: identified as PrEP-eligible, who initiate PrEP, who adhere to PrEP (i.e., refills over 6 mos.), who seroconvert, and who discontinue PrEP, overall and by socio-demographic characteristics (e.g., gender). We will engage with Ugandan Ministry of Health policymakers throughout the research, to keep them apprised of results and to determine directions for future policy around PrEP for fisherfolk. To realize the 90- 90-90 goals, it is critical to seek out the hardest to reach, most at-risk populations such as fisherfolk, who reside and work in areas without easy access to healthcare.

项目摘要 在乌干达渔民社区中，艾滋病毒的患病率比乌干达高的数量级 渔民中普通人群和艾滋病毒率高有助于推动一般流行病。在先前 R21研究，我们证明了将艾滋病毒测试带到医疗机构所在的Fisherfolk社区 稀缺，可以识别大量高风险的HIV阴性渔民。对艾滋病毒产生重大影响 Fisherfolk的流行病，该研究计划的下一步是提供预暴露 预防（准备；一种高效且安全的每日药丸，含有替诺福韦和Emtricitabine，以防止HIV） HIV测试后，高风险的HIV阴性渔民。尽管2016年乌干达艾滋病毒预防和 治疗指南建议为Fisherfolk预防艾滋病毒预防准备，目前没有政府 支持在Fisherfolk社区实施准备。迫切需要数据以证明 为了确保政府的确保 支持Fisherfolk的准备。具体目的是：（1）进行形成性定性研究以检查 预先吸收的障碍和促进者，并获得可接受的预备消息和提供的意见， 对于乌干达维多利亚湖的Fisherfolk社区； （2）进行比较的混合方法分析 基于社区与医疗机构的实施基于渔民社区的预备准备 在乌干达维多利亚湖上。对于两种准备干预措施，我们将每月进行HIV测试和PREP，以及 抗逆转录病毒治疗供应事件，使用形成性工作开发的消息来提高 对准备的意识。预测试期间，将向两个维多利亚湖登陆场的100个渔民提供准备 每月指定日期的事件：在一个站点中，预备将在附近的医疗机构中分发 每月活动，在另一个站点中，准备将在临时的社区空间中分发。其中 谁是不遵守的（基于补充数据），将通过预备通过准备补充准备。 社区卫生工作者或社区准备提升点，基于形成性的策略 工作。为了评估实施，我们将对医疗保健提供者和 菲什福克（Fisherfolk Fisherfolk的比例：被确定为PREP合格，启动Prep，坚持准备的人（即，超过6 Mos。 性别）。在整个研究中，我们将与乌干达卫生部决策者互动，以保持他们 告知结果，并确定Fisherfolk准备未来政策的指示。实现90- 90-90的进球，寻找最难达到的目标至关重 居住并在不容易获得医疗保健的地区工作。