Social and psychological predictors of PrEP adherence among adolescent girls and young women in Eastern and Southern Africa

东部和南部非洲少女和年轻女性坚持 PrEP 的社会和心理预测因素

• 批准号: 10087797
• 负责人: Danielle Giovenco
• 金额: $ 3.75万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10087797
• 关键词: 18 year old; AIDS prevention; Address; Adherence; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Affect; Africa South of the Sahara; African; Age-Years; Anti-Retroviral Agents; Biological; Blood; Chronic Disease; Clinical Trials; Data; Development; Disclosure; Drug usage; Eastern Africa; Epidemic; Epidemiologist; Fellowship; Female Adolescents; Follow-Up Studies; Foundations; Fumarates; Funding; Future; Growth; HIV; HIV Infections; Infection; Investigation; Knowledge; Link; Literature; Longitudinal cohort; Measures; Mental Depression; Oral; Outcome; Outcome Study; Parents; Participant; Pattern; Population; Prevention; Prevention Research; Prevention strategy; Process; Psychological Factors; Research; Research Personnel; Research Project Grants; Research Training; Risk; Sampling; Science; Site; Social support; South Africa; Southern Africa; Spottings; Tanzania; Tenofovir; Training; Woman; antiretroviral therapy; career; clinically significant; cohort; depressive symptoms; emtricitabine; global health; high risk population; implementation strategy; improved; insight; male; peer; pre-exposure prophylaxis; prospective; psychologic; skills; social; social factors; social group; young woman

PROJECT ABSTRACT Adolescents and young adults account for over one-third of all new global infections of HIV, representing a key population for prevention efforts. In sub-Saharan Africa, adolescent girls and young women (15-24) are more than twice as likely to become infected with HIV compared to their male counterparts and contribute nearly 25% of all new HIV infections in the region. Antiretroviral pre-exposure prophylaxis, or PrEP, has been found in clinical trials to be an efficacious biomedical HIV prevention strategy that holds enormous potential to reduce HIV acquisition in key populations globally. Among young African women, however, a range of adherence outcomes have been observed, with low adherence compromising PrEP efficacy in several trails. Further, adolescents under 18 years of age remain inadequately represented in PrEP research, posing a significant challenge for understanding how to deliver PrEP to young people with a focus on maximizing adherence. Research is needed to identify specific considerations relevant to the implementation of PrEP among adolescent girls and young women in generalized HIV epidemic settings. The objective of this study is to examine how disclosure of PrEP use and depression impact continuation of and adherence to daily oral PrEP among adolescent girls and young women in Eastern and Southern Africa. The specific aims of this research are to: (1) examine the association between disclosure of PrEP use to parents, partners, and peers and PrEP continuation and adherence; and (2) determine if depression is associated with PrEP continuation and adherence. This study will utilize longitudinal cohort data from EMPOWER, a multi-site prospective PrEP implementation study conducted among young women at substantial risk for HIV infection in Johannesburg, South Africa and Mwanza, Tanzania. A sample of 418 adolescent girls and young women (16-24 years of age) from the EMPOWER cohort who initiated daily oral PrEP will be included in this investigation. Participants were followed quarterly for up to 15 months. Adherence to PrEP, the primary study outcome, will be measured retrospectively using drug levels in dried blood spot samples for a biologic assessment of PrEP use. This investigation can help inform PrEP implementation strategies among adolescent girls and young women by providing insight into the social and psychological dynamics that facilitate adherence. To support the successful execution of this research project and promote the applicant’s growth into an independent investigator, additional training during the fellowship period will be sought to enhance the applicant’s collaborative research network, quantitative analysis skills, and interdisciplinary subject matter knowledge. Together, this proposed research and training plan will lay the foundation for the applicant’s future career as an independently funded epidemiologist focused on global health and HIV prevention research.

项目摘要 青少年和青壮年占全球新发艾滋病毒感染者的三分之一以上，占 在撒哈拉以南非洲地区，少女和年轻女性（15-24 岁）是预防工作的重点人群。 与男性四肢相比，感染艾滋病毒的可能性高出两倍以上，并有助于 该地区近 25% 的新发艾滋病毒感染者接受了抗逆转录病毒暴露前预防 (PrEP)。 临床试验已发现这是一种有效的生物医学艾滋病毒预防策略，具有巨大的应用价值 然而，在非洲年轻女性中，有可能减少全球重点人群的艾滋病毒感染。 观察到一系列依从性结果，低依从性会影响 PrEP 的疗效 此外，18 岁以下的青少年在 PrEP 中的代表性仍然不足。 研究，对​​理解如何向有能力的年轻人提供 PrEP 提出了重大挑战 需要重点关注最大限度地提高依从性，以确定与此相关的具体考虑因素。 在普遍艾滋病毒流行地区的少女和年轻妇女中实施暴露前预防措施。 本研究的目的是探讨 PrEP 使用和抑郁症的披露如何影响继续使用 PrEP 东部和南部地区少女和年轻女性每日口服 PrEP 的坚持情况 非洲。本研究的具体目的是：(1) 研究 PrEP 披露之间的关联。 用于父母、伴侣和同伴以及 PrEP 的继续和坚持；(2) 确定是否患有抑郁症； 与 PrEP 的继续和依从性相关。本研究将利用来自的纵向队列数据。 EMPOWER，一项在年轻女性中进行的多地点前瞻性 PrEP 实施研究 南非约翰内斯堡和坦桑尼亚姆万扎的 HIV 感染风险很大 418 名样本。 来自 EMPOWER 队列的青春期女孩和年轻女性（16-24 岁）开始每天口服 PrEP 将纳入本次调查，每季度对参与者进行一次长达 15 个月的跟踪调查。 主要研究结果 PrEP 的依从性将使用干燥药物中的药物水平进行回顾性测量。 用于 PrEP 使用生物学评估的血斑样本 这项调查有助于为 PrEP 提供信息。 通过提供对社会的深入了解，在少女和年轻妇女中实施战略 和促进坚持的心理动力学。 项目并促进申请人成长为独立研究者，期间进行额外培训 研究金期将寻求加强申请人的合作研究网络、定量研究 分析技能和跨学科主题知识一起，提出了研究和 培训计划将为申请人作为独立资助的未来职业生涯奠定基础 流行病学家专注于全球健康和艾滋病毒预防研究。