Design and delivery of combination HIV prevention in young South African women

为南非年轻女性设计和实施艾滋病毒综合预防

• 批准号: 9122498
• 负责人: Linda-Gail Gail Bekker
• 金额: $ 35万
• 依托单位: DESMOND TUTU HIV FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-07 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9122498
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adoption; African; Age; Behavior; Behavioral; Blinded; Cellular Phone; Characteristics; Communication; Counseling; Couples; Development; Effectiveness; Enrollment; Evaluation; Future; HIV; HIV risk; Habits; Health; Human immunodeficiency virus test; Incentives; Incidence; Intention; Intervention; Knowledge; Life; Male Circumcision; Medical; Modeling; Motivation; Oral; Outcome; Perception; Pharmaceutical Preparations; Prevention; Prevention strategy; Preventive Intervention; Prophylactic treatment; Qualitative Methods; Random Allocation; Reaction; Research; Rewards; Risk; Risk Assessment; Risk Reduction; Role; South Africa; South African; Surveys; Tenofovir; Testing; Woman; antiretroviral therapy; arm; base; behavioral economics; cohort; condoms; design; effective intervention; evidence base; experience; improved; information framework; male; men; novel strategies; outreach; pill; placebo controlled study; programs; randomized trial; risk perception; skills; social; therapy design; tool; treatment adherence; uptake; young man; young woman

 DESCRIPTION (provided by applicant): Young women in South Africa have an annual HIV incidence of 6-10% and are a high priority group for combination HIV prevention, including HIV testing, condoms and risk reduction counseling, partner HIV testing, modest cash transfers and oral pre-exposure prophylaxis (PrEP). PrEP has demonstrated efficacy (44-75% in randomized trials, >90% with high adherence) and is user-controlled, yet young African women in two blinded, placebo-controlled trials of PrEP had very low adherence, resulting in no demonstrated effectiveness in the context of very high HIV incidence. These results raise key questions for HIV prevention in women about perception of low HIV acquisition risk, lack of motivation in a placebo-controlled trial, barriers to taking a daily pill, partner support or lack, or low interestin HIV prevention. Programs that deliver combination prevention to young South African women need a better understanding of what motivates them to use combination prevention, how they recognize their risk, evaluate evidence and apply this to adoption of prevention strategies. We will conduct formative research about how women understand their risks and the role of intimate partners, which we hypothesize, are central determinants of intention, motivation, adoption of and adherence to HIV prevention strategies. We will use complimentary frameworks of the Information-Motivations-Behavior (IMB) skills model for qualitative inquiry and behavioral economics (BE) for quantitative approaches to identify levers to change prevention decisions and develop practical messaging and interventions. We will use qualitative methods and experimental HIV risk vignette surveys among young HIV-negative women in Cape Town, South Africa to assess risk perception and motivations to adopt HIV prevention interventions. Findings will inform development of a pilot intervention designed to provide proof of concept that an intervention based on better communication about risk and partner engagement facilitates uptake of combination prevention including PrEP, and a short-lived modest cash incentive conditional on presence of detectable PrEP drug levels, will enhance persistent adherence among women initiating PrEP. The intervention to improve HIV risk evaluation and partner involvement for HIV prevention adoption, including CCI for PrEP adherence, will be evaluated in a cohort of 100 HIV-negative women in Cape Town. Our Specific Aims are to: Aim 1: Conduct formative research about male partners, related social factors and motivators that facilitate young South African women's uptake of and adherence to HIV prevention. Aim 2: Pilot strategies for testing the partners of young South African women and evaluate whether partner testing is associated with uptake of prevention by women. Aim 3: Implement a prevention intervention among young South African women using research findings about risk evaluation and other motivators and assess whether these interventions together with short-term CCI will enhance PrEP uptake and adherence in the presence or absence of partner involvement. These knowledge gaps must be addressed for future trials of biomedical prevention strategies and implementation of combination prevention with effective interventions for young African women.

 描述（由申请人提供）：南非年轻女性的艾滋病毒年发病率为 6-10%，是艾滋病毒综合预防的高度优先群体，包括艾滋病毒检测、安全套和降低风险咨询、伴侣艾滋病毒检测、适度现金转移口服暴露前预防 (PrEP) 已被证明有效（随机试验中为 44-75%，依从性较高，>90%），并且是用户控制的，但年轻的非洲女性在两项盲法研究中进行了研究。 PrEP 的安慰剂对照试验的依从性非常低，导致在艾滋病毒发病率非常高的情况下没有显示出有效性。这些结果提出了女性艾滋病毒预防的关键问题，即对艾滋病毒感染风险低的看法，以及安慰剂缺乏动力。对照试验、每日服用药物的障碍、伴侣的支持或缺乏，或对艾滋病毒预防的兴趣较低。我们将评估证据并将其应用于预防策略的采用。我们参与的关于女性如何理解其风险和亲密伴侣的作用的形成性研究是艾滋病毒预防策略的意图、动机、采用和遵守的核心决定因素。我们将使用信息-动机-行为（IMB）的补充框架。 ）定性调查和行为经济学（BE）的模型技能，用于定量方法，以确定改变预防决策的杠杆，并制定实用的信息和干预措施。我们将在开普敦的年轻艾滋病毒阴性女性中使用定性方法和实验性艾滋病毒风险调查，南非评估采取艾滋病毒预防干预措施的风险认知和动机将为制定一项试点干预措施提供信息，该干预措施旨在提供概念证明，即基于更好的风险沟通和合作伙伴参与的干预措施有助于采取包括 PrEP 在内的组合预防措施和短期适度的预防措施。以可检测到的 PrEP 药物水平为条件的现金奖励将提高开始 PrEP 的女性的持续依从性。将在 100 人的队列中对旨在改善 HIV 风险评估和合作伙伴参与 HIV 预防采用的干预措施（包括用于 PrEP 依从性的 CCI）进行评估。开普敦艾滋病毒阴性妇女的具体目标是： 目标 1：对男性伴侣、相关社会因素和动机进行形成性研究，以促进南非年轻妇女接受和坚持艾滋病毒预防措施 目标 2：检测试点策略。目标 3：利用有关风险评估和其他激励因素的研究结果，在南非年轻女性中实施预防干预措施，并评估这些干预措施是否与南非年轻女性的伴侣接受预防措施有关。无论是否有合作伙伴参与，短期 CCI 都将提高 PrEP 的采用和依从性，以便未来试验生物医学策略并实施联合预防和有效干预措施，以预防非洲年轻女性。