Making women's options for HIV prevention in Tanzania accessible and joining implementation science capacity building (MWOTAJI)

为坦桑尼亚妇女提供预防艾滋病毒的选择并参与实施科学能力建设 (MWOTAJI)

• 批准号: 10749077
• 负责人: Mackfallen Giliadi Anasel
• 金额: $ 125.73万
• 依托单位: CENTRE OF EXCELLENCE IN HEALTH MONITORING AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10749077
• 关键词: AIDS prevention; Adoption; Africa; Africa South of the Sahara; Age; Area; Awareness; Businesses; California; Caring; Clinic; Clinical Research; Collaborations; Communities; Contraceptive Agents; Contraceptive methods; Cost Sharing; Counseling; Coupled; Dapivirine; Data; Development; Ensure; Environment; Face; Female Adolescents; Friends; Future; Goals; Government; Grant; HIV; HIV Infections; Health; Health Services; Health care facility; Health system; Household; Incentives; Incidence; Infection; Infrastructure; Injectable; Knowledge; Lead; Location; Maintenance; Modeling; Modernization; Oral; Outcome; Pharmaceutical Preparations; Pharmacy facility; Pilot Projects; Policies; Policy Maker; Population; Prevention Research; Prevention strategy; Private Sector; Privatization; Prospective cohort; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Records; Reproductive Health Services; Research; Research Personnel; Resources; San Francisco; Services; Sexual Health; Sexuality; Site; Surveys; Tanzania; Time; Training; Training Programs; Universities; Woman; Youth; adolescent HIV prevention; certificate program; cohort; design; effectiveness outcome; effectiveness study; effectiveness/implementation study; empowerment; epidemic response; evidence base; girls; high-risk adolescents; implementation evaluation; implementation framework; implementation outcomes; implementation research; implementation science; implementation strategy; innovation; performance site; pill; pre-exposure prophylaxis; programs; public-private partnership; randomized trial; self testing; social stigma; success; unintended pregnancy; uptake; vulnerable adolescent; young woman

SUMMARY Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face a disproportionate burden of HIV infection. Though highly effective HIV prevention like pre-exposure prophylaxis (PrEP) is central to the global strategy for HIV epidemic control, awareness of PrEP among AGYW is low, with uptake and continuation even lower—health systems are often ill equipped to overcome the numerous access barriers faced by AGYW, including stigma, harmful norms, and the inconveniences of clinic-based health services. There is growing recognition that community-based pharmacies have the potential to bridge gaps in HIV prevention and mitigate access barriers among AGYW. Thus, the goal of this study is to evaluate the Malkia Klabu (“Queen Club”) implementation strategy in Tanzania, a loyalty program designed for and by AGYW that creates youth-friendly pharmacies where AGYW can access HIV prevention and sexual and reproductive health (SRH) services, with strong linkages to facility-based care. Based on promising data from our pilot study, we hypothesize that the creation of a welcoming and safe pharmacy environment through the Malkia Klabu implementation model will attract AGYW and bolster uptake of PrEP, HIV self-testing (HIVST), and other SRH services, thereby empowering AGYW to avoid HIV and unintended pregnancy. We have designed an innovative, 5-year implementation science study to scale and evaluate several models of Malkia Klabu’s pharmacy-based approach for PrEP and HIVST delivery in five research sites in Lake Zone, Tanzania using the RE-AIM framework. This research will be enhanced by implementation science training of local researchers and policymakers to optimize Malkia Klabu and benefit future HIV prevention strategies. We will first conduct a Type 3 Hybrid Implementation-Effectiveness study of four pharmacy-based differentiated PrEP delivery models of Malkia Klabu in 50 pharmacies, examining implementation outcomes before and after the addition of user cost-sharing which is essential for real-world sustainability (Aim 1). We will examine the success of the Malkia Klabu delivery models on effective use of PrEP among a cohort of 575 AGYW, reach of the program in a cross-sectional household survey with 750 AGYW in study areas; pharmacy exit surveys with ~200 AGYW will help describe the success of pharmacy- based PrEP service offerings (Aim 2). A Certificate in Implementation Science coupled with seed grants for graduates will ensure the project has lasting impact (Aim 3). At the study’s conclusion, we will determine the strongest and most sustainable version of the Malkia Klabu implementation strategy for pharmacy-based PrEP and HIVST delivery to AGYW, and launched an implementation science training program to enable locally-led scaling and adaptation to reach vulnerable AGYW across Tanzania and the Region. The project is a collaboration between Mzumbe University, Health for a Prosperous Nation, the Tanzania Ministry of Health, and University of California (San Francisco & Berkeley).

概括 撒哈拉以南非洲地区的少女和年轻女性（AGYW；15-24 岁）面临着不成比例的负担 虽然暴露前预防 (PrEP) 等高效的 HIV 预防是艾滋病毒感染的核心。 艾滋病毒流行控制全球战略中，AGYW 对 PrEP 的认识较低，吸收率和 持续性甚至更低——卫生系统往往无力克服众多准入障碍 AGYW 面临的问题包括耻辱、有害规范以及诊所卫生服务的不便。 人们越来越认识到社区药房有潜力弥补艾滋病毒方面的差距 因此，本研究的目的是评估 Malkia。 Klabu（“女王俱乐部”）在坦桑尼亚的实施战略，这是一项由 AGYW 设计并由 AGYW 设计的忠诚度计划， 创建青年友好型药房，AGYW 可以在那里获得艾滋病毒预防以及性和生殖服务 健康 (SRH) 服务，与基于设施的护理有着密切的联系。 根据我们的试点研究的有希望的数据，我们发现创建一个受欢迎和安全的环境 通过 Malkia Klabu 实施模式打造的药房环境将吸引 AGYW 并促进采用 PrEP、艾滋病毒自检 (HIVST) 和其他性健康和生殖健康服务，从而使 AGYW 能够避免艾滋病毒和 我们设计了一项创新性的、为期 5 年的实施科学研究，以扩大规模并进行研究。 在五年内评估 Malkia Klabu 基于药房的 PrEP 和 HIVST 交付方法的几种模型 坦桑尼亚湖区的研究地点使用 RE-AIM 框架，该研究将得到加强。 对当地研究人员和政策制定者进行实施科学培训，以优化 Malkia Klabu 并从中受益 未来的艾滋病毒预防策略。我们将首先进行 3 类混合实施有效性研究。 Malkia Klabu 在 50 家药房的四种基于药房的差异化 PrEP 交付模式，正在审查 添加用户成本分摊前后的实施结果，这对于现实世界至关重要 可持续性（目标 1）我们将研究 Malkia Klabu 交付模式在有效利用方面的成功。 PrEP 在 575 名 AGYW 人群中进行，在对 750 名 AGYW 进行的横断面家庭调查中，该计划的覆盖范围 研究领域的 AGYW；约 200 个 AGYW 的药房出口调查将有助于描述药房的成功 基于 PrEP 服务产品（目标 2）的实施科学证书以及种子补助金。 毕业生将确保该项目具有持久影响（目标 3）。 在研究结论中，我们将确定 Malkia Klabu 的最强且最可持续的版本 向 AGYW 提供基于药房的 PrEP 和 HIVST 实施战略，并启动了 实施科学培训计划，使当地主导的扩展和适应惠及弱势群体 AGYW 横跨坦桑尼亚和该地区，该项目是姆宗贝大学与 Health for 之间的合作。 繁荣国家、坦桑尼亚卫生部和加州大学（旧金山和伯克利）。