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

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.

项目概要 在乌干达渔民社区，艾滋病毒感染率比乌干达高一个数量级 普通人群和渔民中的艾滋病毒高感染率有助于推动艾滋病毒的普遍流行。在之前的 R21 研究表明，将艾滋病毒检测带到医疗设施匮乏的渔民社区 稀缺，可以识别大量艾滋病毒阴性的高危渔民。对艾滋病毒产生重大影响 由于在渔民中流行，该研究计划的下一步关键是提供预暴露 预防（PrEP；一种高效且安全的每日药片，含有替诺福韦和恩曲他滨，用于预防艾滋病毒） 艾滋病毒检测后艾滋病毒呈阴性的高危渔民。尽管 2016 年乌干达艾滋病毒预防和 治疗指南建议对渔民进行 PrEP 预防艾滋病毒，但目前政府还没有 支持渔民社区实施 PrEP。迫切需要试点数据来证明 乌干达卫生部表示，可以向渔民提供 PrEP，以确保政府的安全 对渔民的 PrEP 的支持。具体目标是： (1) 进行形成性定性研究以检验 PrEP 采用的障碍和促进因素，并获取有关可接受的 PrEP 信息和提供的意见， 为乌干达维多利亚湖的渔民社区； (2) 进行混合方法分析比较 为渔民社区实施基于社区的 PrEP 服务与基于医疗机构的 PrEP 服务 乌干达维多利亚湖。对于这两种 PrEP 干预措施，我们将每月进行 HIV 检测以及 PrEP 和 抗逆转录病毒治疗提供活动，利用形成工作中形成的信息来提高 对 PrEP 的认识。在测试期间，将向维多利亚湖两个登陆点的 100 名渔民提供 PrEP 每月指定日期的活动：在一个地点，PrEP 将在期间分发到附近的医疗机构 每月一次的活动，而在另一个地点，PrEP 将在临时社区空间中分发。其中 对于不遵守规定的人（基于补充数据），PrEP 规定将通过 PrEP 交付进行补充 社区卫生工作者或社区 PrEP 接机点，基于形成过程中提出的策略 工作。为了评估实施情况，我们将与医疗保健提供者进行半结构化访谈 决定启动 PrEP 和不启动 PrEP 的渔民，并获取医疗记录数据以比较 渔民比例：确定为有 PrEP 资格、启动 PrEP、坚持 PrEP（即补充超过 6 个） mos.），谁血清转化，谁停止 PrEP，总体上和社会人口特征（例如， 性别）。我们将在整个研究过程中与乌干达卫生部的政策制定者进行接触，以确保他们 通报结果并确定有关渔民 PrEP 的未来政策方向。实现90- 90-90 目标中，找出最难接触到、风险最高的人群（例如渔民）至关重要。 在不易获得医疗保健的地区居住和工作。