Optimizing PrEP Engagement Among Women Who Use Drugs in Tanzania

优化坦桑尼亚吸毒女性的 PrEP 参与

• 批准号: 10700455
• 负责人: Haneefa Tasleem Saleem
• 金额: $ 23.71万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700455
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adult; Anxiety; Anxiety Disorders; Behavior; Cognitive Therapy; Communities; Community Health Aides; Dependence; Diagnostic; Drug usage; Drug user; Economics; Educational Intervention; Elements; Epidemic; Evidence based intervention; Feasibility Studies; Focus Groups; Funding; Goals; HIV; Health; Heroin; High Prevalence; Hybrids; Incidence; Intervention; Interview; Mental Depression; Mental Health; Mental disorders; Modeling; Mood Disorders; Motivation; Needs Assessment; Phase; Pilot Projects; Population; Post-Traumatic Stress Disorders; Prevalence; Prevention strategy; Professional counselor; Psychotherapy; Randomized, Controlled Trials; Research; Services; Shoulder; Specialist; Structure; Substance Use Disorder; Supervision; Surveys; Tanzania; Testing; Treatment Efficacy; Treatment outcome; Vulnerable Populations; Woman; Work; anxiety symptoms; arm; associated symptom; depressive symptoms; effectiveness-implementation RCT; experience; feasibility trial; health training; high risk population; housing instability; improved; inattention; innovation; intervention delivery; intervention effect; low and middle-income countries; male; men; motivational enhancement therapy; novel; opioid use; peer; pilot test; post-traumatic stress; pre-exposure prophylaxis; primary outcome; secondary outcome; sex; sexual violence; substance use; syndemic; uptake

PROJECT SUMMARY Women who use drugs (WWUD), specifically heroin, shoulder a disproportionate burden of the HIV epidemic in Tanzania. Despite advances in HIV prevention biomedical interventions, including pre-exposure prophylaxis (PrEP), PrEP uptake has been slow in Tanzania. Mental disorders, including depression, anxiety, and post- traumatic stress disorder, are high among WWUD and are known barriers to HIV prevention behaviors, including PrEP engagement. Inattention to the high prevalence of mental health problems in WWUD, is likely to undermine efforts to increase the use of HIV prevention strategies, including PrEP, among this highly vulnerable, yet understudied population. Motivational interviewing (MI) and cognitive-behavioral therapy (CBT) are evidence-based interventions that have been successfully delivered by paraprofessionals, both globally and in Tanzania, for a range of health conditions, including substance use disorders and mental disorders, and to improve uptake and adherence of HIV prevention strategies. The Common Elements Treatment Approach (CETA) is a transdiagnostic, CBT-based intervention developed for use in low- and middle-income countries for delivery by lay counselors with no or limited previous mental health training. The goal of this study is to adapt MI for PrEP engagement (MI-PrEP) and a combined CETA and MI-PrEP interventions (CETA+MI-PrEP) for delivery by paraprofessionals in Dar es Salaam, Tanzania, to optimize PrEP engagement among WWUD. The specific aims of this study are to: (1) identify barriers and motivators to PrEP engagement, and the types of paraprofessionals who could most effectively deliver the MI-PrEP and CETA+MI- PrEP interventions using in-depth interviews and focus groups with WWUD, peer- and non-peer community health workers, lay counselors, and mental health specialists, (2) systematically adapt MI-PrEP and CETA for WWUD with co-occurring mental disorders in Tanzania using the ADAPT-ITT model, and (3) assess the feasibility, fidelity, and preliminary efficacy of the MI-PrEP and CETA+MI-PrEP interventions in a three-arm pilot feasibility trial with 120 WWUD with co-occurring symptoms of mental disorders. A combination of interviews, structured surveys, and supervision will be used to assess for intervention feasibility and fidelity. The preliminary efficacy of the intervention will be estimated for the primary outcomes of PrEP engagement and secondary outcomes of opioid use, symptoms of depressive, anxiety, and post-traumatic stress, and PrEP motivation and barriers. This pilot feasibility study will: (1) advance our understanding of the unique factors that contribute to the PrEP engagement among WWUD, (2) address the HIV prevention needs of an understudied, yet extremely high-risk population, and (3) result in culturally appropriate and locally adapted MI-PrEP and CETA+MI-PrEP interventions that can be formally tested in a Hybrid Type I Effectiveness- Implementation randomized controlled trial.

项目概要 吸毒（WWUD），特别是海洛因的女性，在艾滋病毒流行中承担着不成比例的负担 在坦桑尼亚。尽管艾滋病毒预防生物医学干预措施（包括暴露前预防）取得了进展 (PrEP)，坦桑尼亚的 PrEP 吸收速度缓慢。精神障碍，包括抑郁、焦虑和产后抑郁症 创伤性应激障碍在 WWUD 中发病率很高，并且是 HIV 预防行为的已知障碍， 包括 PrEP 参与。很可能忽视了 WWUD 中心理健康问题的高患病率 破坏为增加使用艾滋病毒预防策略（包括 PrEP）而做出的努力 弱势但未被充分研究的人群。动机访谈（MI）和认知行为疗法 (CBT) 是由辅助专业人员成功实施的基于证据的干预措施， 在全球和坦桑尼亚，针对一系列健康状况，包括药物滥用障碍和精神障碍 疾病，并提高艾滋病毒预防策略的采用和依从性。共同元素 治疗方法 (CETA) 是一种基于认知行为治疗 (CBT) 的跨诊断干预措施，专为低血压和低血压患者而开发。 中等收入国家由未接受过心理健康培训或之前接受过有限心理健康培训的非专业咨询师提供服务。这 本研究的目标是使 MI 适应 PrEP 参与 (MI-PrEP) 以及 CETA 和 MI-PrEP 的结合 在坦桑尼亚达累斯萨拉姆由专业人员提供干预措施 (CETA+MI-PrEP)，以优化 PrEP WWUD 的参与。本研究的具体目的是：（1）确定 PrEP 的障碍和动机 参与度，以及能够最有效地提供 MI-PrEP 和 CETA+MI- 的专业人员辅助人员类型 通过与 WWUD、同伴和非同伴社区进行深入访谈和焦点小组进行 PrEP 干预 卫生工作者、非专业咨询师和心理健康专家，(2) 系统地调整 MI-PrEP 和 CETA 使用 ADAPT-ITT 模型对坦桑尼亚的 WWUD 与并发精神障碍进行评估，以及 (3) 评估 三臂 MI-PrEP 和 CETA+MI-PrEP 干预的可行性、保真度和初步疗效 对 120 名同时出现精神障碍症状的 WWUD 进行试点可行性试验。的组合 将使用访谈、结构化调查和监督来评估干预的可行性和保真度。 将根据 PrEP 参与的主要结果来估计干预措施的初步效果 阿片类药物使用的次要结果、抑郁、焦虑和创伤后应激症状以及 PrEP 动机和障碍。该试点可行性研究将：(1) 加深我们对独特因素的理解 有助于 WWUD 之间的 PrEP 参与，(2) 解决艾滋病毒预防需求 未充分研究但风险极高的人群，以及 (3) 产生适合文化和当地适应的结果 MI-PrEP 和 CETA+MI-PrEP 干预措施可以在混合 I 型有效性中进行正式测试 - 实施随机对照试验。