Multilevel Comprehensive HIV Prevention for South African Adolescent Girls and Young Women

南非少女和年轻妇女的多层次综合艾滋病毒预防

基本信息

批准号：
10229121
负责人：
GERI R DONENBERG
金额：
$ 81.48万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10229121
关键词：
18 year old 19 year old AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adolescent Adopted Africa Africa South of the Sahara Alcohol consumption Area Behavior Biomedical Technology Caregivers Caring Continuity of Patient Care Cost Control Counseling Data Decision Making Discrimination Drug usage Economics Educational Curriculum Effectiveness Epidemic Epidemiology Evaluation Evidence based intervention Failure Family Female Female Adolescents Foundations Generations Goals Government HIV HIV Infections HIV risk HIV/STD Health Health Promotion Human immunodeficiency virus test Incidence Individual Infection Intervention Mediator of activation protein Mental disorders Methodology Modeling Outcome Phase Pilot Projects Politics Prevalence Prevention Prevention program Primary Prevention Process Public Health Reporting Research Resources Risk Risk Behaviors Safe Sex Science Services Sex Behavior Shapes Site South Africa South African Testing Time Woman Youth age group arm base behavior change compare effectiveness condoms cost cost effectiveness cost-effectiveness evaluation data sharing design effectiveness evaluation experience follow-up girls high risk sexual behavior improved innovation male men metropolitan mortality multidisciplinary novel peer phase II trial pre-exposure prophylaxis prevent programs public health priorities role model sexual risk behavior sexual risk taking social culture social stigma social structure stem transmission process uptake young woman

项目摘要

ABSTRACT Reducing new HIV and STI infections among South African (SA) adolescent girls and young women (AGYW) is global public health priority.1 SA has world's largest HIV epidemic,2,3 and SA AGYW acquire HIV at twice the rate of and seroconvert on average 5 – 7 years earlier than male peers.3 As new infections continue to outpace access to and availability of PrEP and ART, primary prevention remains the most viable strategy to stem new transmissions.1,4,5 SA efforts to prevent HIV transmission in youth focus mostly on individual-level behavior change,6-8 but AGYW's persistent HIV disparities are explained by broad social and structural inequities that shape and constrain HIV-risk behaviors.9-14 Comprehensive HIV prevention packages that are integrated, synergistic, and tailored to the local epidemiology and cultural context are likely to achieve and sustain maximum reductions in HIV-risk.15-22 Female caregivers (FC) are an untapped resource in the HIV prevention toolbox23,24 and offer a novel opportunity to strengthen AGYW prevention efforts. AGYW may also be change agents for their FC who want to be positive role models for AGYW, and thus, adopt HIV prevention behaviors, including HTC and PrEP. Guided by an ecological framework, our highly experienced multidisciplinary team will adapt (phase 1/UG3) and evaluate the effectiveness and cost-effectiveness of (phase 2/UH3) IMARA, a multilevel, innovative, family-based HIV prevention program that targets individual, social, and structural drivers of risk to decrease HIV and STI incident infections, reduce risky sexual behavior, and increase HTC and PrEP uptake (where appropriate) in AGYW and FC. IMARA demonstrated a 45% reduction in incident STI at 12-month follow-up among black 14-18 year-old girls in the US, and increased HIV testing in FC. Pilot data with 71 AGYW and FC at the Desmond Tutu HIV Foundation (DTHF; study site) confirm feasibility and acceptability of IMARA for the South African context. This study will be integrated into the adolescent-friendly services at DTHF in the Western Cape metropolitan area facilitating sustainability if effective. Using the ADAPT-ITT model, we will systematically tailor IMARA for the SA context and then conduct a 2-arm RCT with 300 15-19 year-old AGYW and FC. FC and AGYW will complete baseline, 6-, and 12-month assessments, including testing for 3 STI. We will offer HTC and PrEP at each assessment and track uptake and linkage to care. AGYW and FC who test positive for a STI and/or HIV will receive free treatment at DTHF. We will collect data to determine the costs of IMARA. Analyses will compare AGYW and FC across the intervention and control programs on sexual risk taking, STI and HIV incidence, PrEP and HTC uptake, and theoretical mediators. The study answers an urgent need to evaluate the effectiveness and cost-effectiveness of combination HIV prevention packages for AGYW to achieve an AIDS-free generation.

抽象的减少南非 (SA) 少女和年轻女性中新的艾滋病毒和性传播感染感染 (AGYW) 是全球公共卫生优先事项。1 南非拥有世界上最严重的艾滋病毒疫情，2,3 和南非 AGYW 收购艾滋病毒感染率是男性同龄人的两倍，血清转化时间平均比男性同龄人早 5 – 7 年。3 感染继续超过 PrEP 和 ART 的获取和可用性，初级预防仍然是阻止新的传播的最可行的策略。1,4,5 SA 努力以青年为重点预防艾滋病毒传播主要是个人层面的行为变化，6-8 但 AGYW 持续存在的艾滋病毒差异可以解释为广泛的社会和结构性不平等塑造和限制了艾滋病毒风险行为。9-14 综合艾滋病毒综合、协同、适合当地流行病学和文化的预防方案环境可能会实现并维持艾滋病毒风险的最大程度降低。15-22 女性护理人员 (FC) HIV 预防工具箱中未开发的资源23,24 并为加强 AGYW 提供了新的机会 AGYW 也可能是其 FC 的变革推动者，他们希望成为积极的榜样。因此，AGYW 采用生态指导下的 HIV 预防行为，包括 HTC 和 PrEP。框架，我们经验丰富的多学科团队将适应（第 1 阶段/UG3）并评估 IMARA（2 期/UH3 期）的有效性和成本效益，IMARA 是一种多层次、创新、基于家庭的 HIV 针对个人、社会和结构风险驱动因素的预防计划，以减少艾滋病毒和性传播感染事件感染，减少危险性行为，并增加 HTC 和 PrEP 的吸收（如适用）在 AGYW 和 FC 中，12 个月的随访显示 STI 事件减少了 45%。美国 14-18 岁黑人女孩，并在 FC 中增加了 71 名 AGYW 和 FC 的艾滋病毒检测。 Desmond Tutu HIV 基金会（DTHF；研究中心）确认 IMARA 的可行性和可接受性这项研究将纳入 DTHF 的青少年友好服务中。如果使用 ADAPT-ITT 模型有效，我们将促进西开普大都市区的可持续发展。必须根据 SA 背景定制 IMARA，然后对 300 名 15-19 岁儿童进行 2 组 RCT AGYW 和 FC。FC 和 AGYW 将完成基线、6 个月和 12 个月的评估，包括测试。对于 3 个 STI，我们将在每次评估时提供 HTC 和 PrEP，并跟踪 AGYW 的吸收和联系。 STI 和/或 HIV 检测呈阳性的 FC 将在 DTHF 接受免费治疗。我们将收集数据以供参考。确定 IMARA 的成本，分析将比较 AGYW 和 FC 的干预和控制。关于性冒险、性传播感染和艾滋病毒发病率、PrEP 和 HTC 吸收以及理论中介的计划。该研究满足了评估组合的有效性和成本效益的迫切需要 AGYW 的艾滋病毒预防一揽子计划，以实现无艾滋病一代。