Innovative strategies to promote biomedical HIV prevention uptake and retention among high-risk adults at drinking venues in Kenya and Uganda

促进肯尼亚和乌干达饮酒场所高危成年人接受和保留生物医学艾滋病毒预防的创新战略

• 批准号: 10693247
• 负责人: Gabriel Chamie
• 金额: $ 59.52万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693247
• 关键词: AIDS prevention; Address; Adherence; Adult; Africa South of the Sahara; Alcohol consumption; Alcohols; Anti-Retroviral Agents; Awareness; Caring; Communities; Consumption; Counseling; Country; Data; Disease; Effectiveness of Interventions; Face; HIV; HIV Seropositivity; HIV risk; HIV therapy; Health; Heavy Drinking; Hot Spot; Human immunodeficiency virus test; Incidence; Injectable; Intervention; Interview; Kenya; Oral; Participant; Perception; Persons; Play; Prevalence; Prevention; Prophylactic treatment; Research; Risk; Risk Factors; Role; Rural; Sampling; Sexual Partners; Site; Testing; Time; Transact; Uganda; Unsafe Sex; Viral; Woman; alcohol use initiation; antiretroviral therapy; arm; barrier to testing; community setting; compare effectiveness; cost effectiveness; cost estimate; drinking; effectiveness measure; effectiveness trial; efficacy evaluation; high risk; innovation; insight; men; phosphatidylethanol; pre-exposure prophylaxis; prevention service; primary outcome; randomized trial; recruit; reduced alcohol use; risk perception; screening; secondary outcome; social stigma; standard care; testing uptake; therapy adherence; transmission process; uptake; AIDS prevention; Address; Adherence; Adult; Africa South of the Sahara; Alcohol consumption; Alcohols; Anti-Retroviral Agents; Awareness; Caring; Communities; Consumption; Counseling; Country; Data; Disease; Effectiveness of Interventions; Face; HIV; HIV Seropositivity; HIV risk; HIV therapy; Health; Heavy Drinking; Hot Spot; Human immunodeficiency virus test; Incidence; Injectable; Intervention; Interview; Kenya; Oral; Participant; Perception; Persons; Play; Prevalence; Prevention; Prophylactic treatment; Research; Risk; Risk Factors; Role; Rural; Sampling; Sexual Partners; Site; Testing; Time; Transact; Uganda; Unsafe Sex; Viral; Woman; alcohol use initiation; antiretroviral therapy; arm; barrier to testing; community setting; compare effectiveness; cost effectiveness; cost estimate; drinking; effectiveness measure; effectiveness trial; efficacy evaluation; high risk; innovation; insight; men; phosphatidylethanol; pre-exposure prophylaxis; prevention service; primary outcome; randomized trial; recruit; reduced alcohol use; risk perception; screening; secondary outcome; social stigma; standard care; testing uptake; therapy adherence; transmission process; uptake

Project Summary HIV incidence remains unacceptably high in sub-Saharan Africa (SSA) due in part to inadequate access, uptake, and retention in biomedical HIV prevention services, including pre- and post-exposure prophylaxis (PrEP/PEP), among persons at increased HIV risk. Alcohol use is a common risk factor for both HIV acquisition and poor HIV prevention uptake and retention in SSA. Interventions that promote biomedical HIV prevention among persons with heavy alcohol use and their sexual partners are urgently needed. Alcohol-serving drinking venues play an important role as sites of HIV transmission in SSA and are ideal sites to engage women and men at increased risk of HIV in biomedical prevention services. However, despite long- standing awareness of drinking venues as transmission “hot spots”, few interventions exist to reach and engage persons in PrEP and PEP from drinking venues in SSA. Major barriers to reaching and engaging persons at high risk of HIV from community settings such as drinking venues in HIV testing – a critical first step to accessing biomedical HIV prevention – include HIV-associated stigma and poor perceptions of risk. To address these barriers, we have developed a mobilization strategy of integrating HIV testing within multi- disease screening to recruit >2,000 people from drinking venues in Kenya and Uganda, reaching >75% of adults recruited for HIV testing. We now need to determine whether multi-disease mobilization can promote uptake of HIV prevention for adults at drinking venues in the context of new biomedical prevention options. Following uptake of biomedical HIV prevention, persons with heavy alcohol use face challenges with retention in care and adherence to PrEP/PEP. We have adapted a brief alcohol counseling intervention (Health Living) to reduce alcohol use and promote antiretroviral therapy (ART) adherence and HIV viral suppression among persons with HIV in Kenya and Uganda. We now need to determine whether this intervention can promote retention in biomedical prevention and PrEP/PEP adherence among adults with heavy alcohol use. The project will rigorously test innovative interventions in Kenya and Uganda to increase uptake and use of biomedical HIV prevention, and assess facilitators, barriers, and cost-effectiveness of these approaches. The project will have the following aims: Aim 1: Compare the effectiveness of two mobilization strategies to increase uptake of biomedical HIV prevention among adults at drinking venues. Aim 2: Determine the efficacy of the Healthy Living Intervention (HLI) to reduce heavy alcohol use vs. standard care (control) on retention in biomedical HIV prevention in a randomized trial among adults with heavy alcohol use. Aim 3: Determine the cost-effectiveness of interventions that increase biomedical HIV prevention uptake (Aim 1) and retention (Aim 2) among adults at high-risk for HIV who attend drinking venues. The proposed research will address the critical intersection of alcohol use and HIV risk in SSA, by promoting reach, uptake and retention in biomedical HIV prevention and exploring associated facilitators and barriers.

项目摘要 撒哈拉以南非洲（SSA）的艾滋病毒事件仍然不可接受，部分原因是访问不足， 吸收和保留生物医学艾滋病毒预防服务，包括预防前和暴露后预防 （PREP/PEP），在艾滋病毒风险增加的人中。饮酒是两种艾滋病毒的常见危险因素 SSA的收购和艾滋病毒预防量不佳。促进生物医学艾滋病毒的干预措施 迫切需要在大量酒精饮酒及其性伴侣中预防。 酒精饮酒场所作为SSA中HIV传播场所起着重要的作用，是理想的地点 让男性和男性在生物医学预防服务中增加艾滋病毒的风险。但是，dospite长 对饮酒场所作为传播的“热点”的认识，几乎没有干预措施可以到达和 让人们参与SSA的饮酒场所的准备和鼓舞。接触和参与的主要障碍 来自社区环境（例如艾滋病毒测试中的饮酒场所）的艾滋病毒高风险的人 - 关键的第一步 获得预防生物医学艾滋病毒 - 包括与艾滋病毒相关的污名和对风险的不良看法。到 解决这些障碍，我们制定了一种动员策略，将艾滋病毒测试整合到多个 疾病筛查可从肯尼亚和乌干达招募> 2,000人，达到> 75％ 成人招募艾滋病毒测试。现在，我们需要确定多疾病动员是否可以促进 在新的生物医学预防选择的背景下，成年人在饮酒场所为艾滋病毒预防吸收。 遵循生物医学艾滋病毒预防的吸收，大量酒精使用的人会面临保留挑战 护理和遵守准备/PEP。我们已经改编了简短的酒精咨询干预措施（健康生活） 减少饮酒并促进抗逆转录病毒疗法（ART）遵守和HIV病毒抑制 在肯尼亚和乌干达有艾滋病毒的人。我们现在需要确定这种干预是否可以促进 在大量酒精饮酒的成年人中保留生物医学预防和prep/pep依从性。 该项目将严格测试肯尼亚和乌干达的创新干预措施，以增加吸收和使用 这些方法的生物医学艾滋病毒预防以及评估促进者，障碍和成本效益。 该项目将具有以下目的：目标1：将两种动员策略的有效性与 增加饮酒场所成年人的生物医学艾滋病毒预防的吸收。目标2：确定效率 健康的生活干预（HLI）以减少大量饮酒与保留的标准护理（控制） 大量酒精使用的成年人的随机试验中，生物医学艾滋病毒的预防。目标3：确定 增加生物医学艾滋病毒预防吸收（AIM 1）和保留的干预措施的成本效益（目标 2）在参加饮酒场所的艾滋病毒高风险的成年人中。 拟议的研究将通过促进SSA的饮酒和艾滋病毒风险的关键交叉 在生物医学艾滋病毒预防中的范围，摄取和保留率，并探索相关的促进者和障碍。