Pharmacy-based PrEP for Young Women who Sell Sex in Zimbabwe

为津巴布韦卖淫的年轻女性提供基于药房的 PrEP

• 批准号: 10704134
• 负责人: Sandra I McCoy
• 金额: $ 27.27万
• 依托单位: CENTRE/SEXUAL HLTH/HIV AID RES/ZIMBABWE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-13 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10704134
• 关键词: AIDS prevention; Address; Adherence; Adult; Africa; Africa South of the Sahara; Age; Behavior Therapy; Behavioral; Bundling; Businesses; Caring; Clinic; Clinic Visits; Communities; Confusion; Contraceptive Agents; Contraceptive methods; Counseling; Dapivirine; Development; Eastern Africa; Epidemic; Evaluation; Feedback; Friends; Future; General Population; Gifts; HIV; HIV Seronegativity; Habits; Hearing; Human immunodeficiency virus test; Incentives; Incidence; Infection; Infrastructure; Injectable; Intervention; Interview; Learning; Measures; Methods; Modeling; Modernization; Motivation; Neighborhoods; Oral; Outcome; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Pregnancy Tests; Prevalence; Prevention; Private Sector; Privatization; Procedures; Process; Proctor framework; Psychosocial Assessment and Care; Randomized; Research Activity; Risk; Services; Sister; Site; Southern Africa; Tanzania; Technology; Translating; Voice; Vulnerable Populations; Woman; Work; Zimbabwe; absorption; behavioral economics; cost; density; design; effective intervention; effectiveness study; effectiveness trial; effectiveness/implementation study; epidemic response; experience; female sex worker; flexibility; girls; high risk; implementation research; implementation science; improved; incentive program; intervention refinement; male; new technology; pill; pre-exposure prophylaxis; primary outcome; programs; randomized trial; self testing; sex; social stigma; standard of care; suburb; therapy design; tool; transgender; transmission process; uptake; young woman

Project Summary Global prevalence of HIV among female sex workers (FSW) is high. In Eastern and Southern Africa 10.4% and 33.3% of FSW are HIV infected. In Zimbabwe, prevalence estimates among FSW are as high as 78% in some regions and incidence is estimated at 5-10% per annum (over 10 times that in adult women more generally), with incidence highest among younger women and those recently engaged in sex work. Modelling suggests that with high uptake and continuation pre-exposure prophylaxis (PrEP) could potentially reduce HIV incidence in FSW by 40%, critical for its own sake but also for epidemic control. Modelling also suggests that 40-80% of all new infections in sub-Saharan Africa by 2035 are likely directly or indirectly attributable to transmission as a result of selling sex. Although PrEP is highly effective and demonstration projects show that PrEP is feasible to deliver and acceptable among FSW in Africa, the majority of sex workers who initiate PrEP stop taking it within the first few months due to a mix of structural and behavioral barriers. Many of these barriers can potentially be addressed through interventions that leverage psychosocial support, behavioral economics and structural issues. We propose to co-develop and evaluate an intervention to directly tackle poor PrEP continuation through a pharmacy-based intervention designed to increase access to PrEP and reduce stigma around its use. If successful, this preliminary study will pave the way for a future effectiveness trial to evaluate this intervention more comprehensively. Using a participatory process, we will work collaboratively with pharmacy owners and FSW to design safe and convenient spaces for PrEP refill pick-ups bundled with HIV self-testing (HIVST) and a gift card incentive (Aim 1); we will then pilot the intervention among women initiating PrEP through CeSHHAR’s existing Sisters with a Voice program to evaluate the impact on PrEP retention at 7 months (Aim 2); finally, using an implementation science approach, we will use mixed-methods to understand the potential for scale of the FSW-focused pharmacy program, and based on the findings, translate lessons learned into the design of a future effectiveness trial (Aim 3). The proposed study will explore whether pharmacies can be used to distribute PrEP refills among FSW. If effective the intervention could be adapted for other PrEP users and for new PrEP technologies as they become available. The results will provide guidance on the acceptability of pharmacy-based PrEP services, bundling PrEP with HIVST and a gift card incentive, and whether pharmacy-based distribution is feasible, acceptable, and worthy of future development.

项目概要 全球女性性工作者 (FSW) 的艾滋病毒感染率在东部和南部非洲高达 10.4%。 在津巴布韦，33.3% 的 FSW 感染艾滋病毒，有些国家的 FSW 感染率估计高达 78%。 地区和发病率估计每年为 5-10%（通常是成年女性的 10 倍以上）， 模型表明，年轻女性和最近从事性工作的女性的发病率最高。 通过高摄入量和持续的暴露前预防 (PrEP) 可能会降低艾滋病毒发病率 FSW 减少 40%，这对于其本身和流行病控制而言至关重要。建模还表明，40-80% 的减少。 到 2035 年，撒哈拉以南非洲地区的所有新感染都可能直接或间接归因于传播 出卖性的结果。 尽管 PrEP 非常有效并且示范项目表明 PrEP 的实施和实施是可行的 尽管在非洲的 FSW 中可以接受，但大多数启动 PrEP 的性工作者在最初几年内就停止服用 由于结构性和行为性障碍，其中许多障碍可能会得到解决。 通过利用社会心理支持、行为经济学和结构性问题的干预措施。 我们建议共同开发和评估一项干预措施，通过以下方式直接解决 PrEP 持续不良问题： 以药房为基础的干预措施，旨在增加 PrEP 的获取并减少其使用带来的耻辱。 成功，这项初步研究将为未来评估这种干预措施的有效性试验铺平道路 我们将通过参与式流程与药房业主和合作伙伴进行更全面的合作。 FSW 将为 PrEP 补充品设计安全且便利的空间，并捆绑 HIV 自检 (HIVST) 和 礼品卡激励（目标 1）；然后，我们将通过以下方式在启动 PrEP 的女性中进行试点干预： CeSHHAR 现有的 Sisters with a Voice 计划评估对 7 个月时 PrEP 保留的影响（目标 2);最后，使用实施科学方法，我们将使用混合方法来了解潜力 确定以 FSW 为重点的药房计划的规模，并根据调查结果，将吸取的经验教训转化为 设计未来有效性试验（目标 3）。 拟议的研究将探讨是否可以使用药房向 FSW 分发 PrEP 补充品。 有效的干预措施可以适用于其他 PrEP 用户和新的 PrEP 技术，因为它们 结果将为基于药房的 PrEP 服务的可接受性提供指导， 将 PrEP 与 HIVST 和礼品卡奖励捆绑在一起，以及基于药房的分发是否可行， 可以接受，值得未来发展。