Maximizing combination HIV prevention, uptake and retention by adolescent girls and young women

最大限度地提高青春期女孩和年轻女性的艾滋病毒预防、感染率和保留率

• 批准号: 10732941
• 负责人: Maryam Shahmanesh
• 金额: $ 20.41万
• 依托单位: KWAZULU-NATAL RESEARCH INSTITUTE TB-HIV
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10732941
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Adolescence; Adolescent; Adult; Affect; Africa South of the Sahara; African; Age; Area; Attitude; Biological Markers; Caring; Clinical; Clinical Services; Communities; Contraceptive methods; Data; Data Collection; Eligibility Determination; Epidemic; Epidemiologist; Event; Exposure to; Family; Female Adolescents; Financial cost; Friends; Gender; Goals; HIV; Health; Health Promotion; Health care facility; Home; Household; Human immunodeficiency virus test; Incidence; Individual; Interdisciplinary Study; Intervention; Interview; Life Cycle Stages; Life Expectancy; Link; Male Circumcision; Medical; Mentors; Mentorship; Methods; Modeling; Outcome Measure; Paper; Persons; Population; Prevention; Provider; Psychologist; Public Sector; Publishing; Random Allocation; Records; Research; Risk; Risk Behaviors; Rural; Sampling; Schools; Science; Scientist; Sex Behavior; Sexual Health; Site; South Africa; Testing; Time; Training; Work; Youth; acceptability and feasibility; adaptive intervention; adolescent HIV prevention; aged; antiretroviral therapy; cohort; condoms; empowerment; family caregiving; follow-up; gender-based violence; high risk; improved; innovation; intervention delivery; male; men; migration; mortality; multidisciplinary; novel; peer; peer networks; peer support; pilot trial; population health; pre-exposure prophylaxis; preventive intervention; programs; prospective; recruit; resilience; response; rural South Africa; scale up; self testing; service uptake; social; social stigma; success; surveillance data; therapy design; therapy development; transmission process; treatment program; uptake; young man; young woman

PROJECT SUMMARY Our overarching goal is to arrest the HIV epidemic and its negative impact on young people in sub-Saharan African (SSA) through improving the uptake, retention, and adherence of multi-level combination HIV prevention by Adolescent Girls and Young Women and male partners. South Africa has an estimated 7.8 million people living with HIV. Despite having the largest HIV treatment program in the world, HIV incidence in Adolescent Girls and Young Women (AGYW aged 15-24) remains high. Whilst there have been significant innovations in HIV prevention, e.g., universal test and treat (UTT) and Pre-exposure prophylaxis (PrEP), this has far outpaced the ability to deliver them. To control the HIV epidemic here is an urgent to significantly improve uptake and retention of HIV care and prevention by AGYW and male partners. In this project we had a unique opportunity to leverage time-sensitive events in a poor and rural hyperendemic area of KwaZulu-Natal: The roll out of eight new youth-focused multi-level HIV prevention interventions for AGYW and their male partners by PEPFAR’s Determined, Resilient, Empowered, AIDS free, Mentored, and Safe (DREAMS) program in the context of a state of the art demographic and health surveillance, where data on individual HIV biomarkers, sexual behaviors, HIV prevention and ART exposure are linked to public-sector clinical records for HIV. We achieved this through three aims. Specific aim 1: We quantified how multiple levels of social dynamics interact to predict uptake of DREAMS components. Specific aim 2: We elucidated how individuals’ life-course and exposure to DREAMS affect retention and adherence to HIV care and prevention. We found that: a) Despite high coverage, DREAMS did not accelerate decline in HIV incidence. b) HIV incidence decline were explained by increases in men’s access to HIV treatment, although barriers remain for young men. c) There is a high unmet sexual health need and self-testing, and self-sampling were popular. d) Targeted Pre-Exposure prophylaxis (PrEP) didn’t reach AGYW most at risk, whilst peer- navigators did. Specific aim 3: Ascertain whether family- and peer-network strategies improve uptake and adherence to combination prevention interventions by young people. We worked with youth to interrogate the findings and co-create an intervention. The result, Thetha Nami, (Talk to Me) consists of trained and supervised peer-navigators who provide health promotion to young people; youth-friendly clinical services; and peer-mentorship to improve retention in HIV prevention. We are currently testing the acceptability and feasibility of this approach on improving adolescents and youth uptake and retention of HIV care and prevention. Our multidisciplinary team includes HIV epidemiologists, a biostatistician, social scientists, psychologist, and intervention development expertise in South Africa. Moving forward, this will provide answers to: ‘Can peers and community-level interventions harness the full mortality and HIV incidence reducing potential of HIV prevention for adolescents and young people in rural SSA?’

项目概要 我们的首要目标是遏制艾滋病毒流行及其对撒哈拉以南地区年轻人的负面影响 非洲（SSA）通过提高多层次组合艾滋病毒的吸收、保留和依从性 南非少女和年轻妇女以及男性伴侣的预防估计为 7.8。 尽管有世界上最大的艾滋病毒治疗计划，但艾滋病毒感染率仍然很高。 青少年女孩和年轻女性（15-24 岁的 AGYW）的比例仍然很高。 HIV 预防方面的重大创新，例如普遍检测和治疗 (UTT) 和暴露前 预防（PrEP），这已经远远超过了提供它们的能力，控制艾滋病毒流行是一项艰巨的任务。 迫切需要显着提高 AGYW 和男性对艾滋病毒护理和预防的接受和保留 在这个项目中，我们有一个独特的机会来利用贫困和农村地区的时间敏感事件。 夸祖鲁-纳塔尔省高流行区：推出八项新的以青年为重点的多层次艾滋病毒预防措施 PEPFAR 的“坚定、有弹性、赋权、无艾滋病”为 AGYW 及其男性伴侣提供的干预措施， 在最先进的人口和健康背景下的指导和安全（DREAMS）计划 监测，其中有关个人艾滋病毒生物标志物、性行为、艾滋病毒预防和抗逆转录病毒治疗暴露的数据 与公共部门的艾滋病毒临床记录相关联 我们通过三个目标实现了这一目标： 量化了多个层面的社会动态如何相互作用来预测 DREAMS 特定成分的吸收。 目标 2：我们阐明了个人的生命历程和对梦想的接触如何影响对梦想的保留和坚持 我们发现： a) 尽管覆盖率很高，DREAMS 并没有加速艾滋病毒的下降。 b) 艾滋病毒发病率下降的原因是男性获得艾滋病毒治疗的机会增加。 c) 存在高度未满足的性健康障碍需求和自我测试和自我采样 d) 针对性的暴露前预防 (PrEP) 并未到达风险最高的 AGYW，而同行 - 具体目标 3：确定家庭和同侪网络策略是否可以提高吸收率和 我们与年轻人一起调查了年轻人对综合预防干预措施的遵守情况。 结果，Thetha Nami（与我交谈）由训练有素的和共同创建的干预措施组成。 受监督的同伴导航员为年轻人提供健康促进；以及 我们目前正在测试其可接受性和有效性。 这种方法对于提高青少年接受和保留艾滋病毒护理的可行性 我们的多学科团队包括艾滋病毒流行病学家、生物统计学家、社会学家。 展望未来，这将是南非的科学家、心理学家和干预开发专业知识。 提供以下问题的答案：“同伴和社区一级的干预措施能否充分利用死亡率和艾滋病毒发病率 降低了农村撒哈拉以南地区青少年和年轻人的艾滋病毒预防潜力？

项目成果

Thetha Nami ngithethe nawe (Let's Talk): a stepped-wedge cluster randomised trial of social mobilisation by peer navigators into community-based sexual health and HIV care, including pre-exposure prophylaxis (PrEP), to reduce sexually transmissible HIV am

Thetha Nami ngithethe nawe（让我们谈谈）：一项阶梯式楔形集群随机试验，由同行引导者进行社会动员，参与基于社区的性健康和艾滋病毒护理，包括暴露前预防 (PrEP)，以减少性传播艾滋病毒

• 发表时间: 2023-08-15
• 影响因子: 4.5
• 作者: Busang, Jacob;Zuma, Thembelihle;Herbst, Carina;Okesola, Nonhlanhla;Chimbindi, Natsayi;Dreyer, Jaco;Mtshali, Nelisiwe;Smit, Theresa;Ngubane, Samkelisiwe;Hlongwane, Siphesihle;Gumede, Dumsani;Jalazi, Ashley;Mdluli, Simphiweyenkosi;Bird, Kristie
• 通讯作者: Bird, Kristie

Acceptability of a tablet-based application to support early HIV testing among men in rural KwaZulu-Natal, South Africa: a mixed method study.

基于平板电脑的应用程序支持南非夸祖鲁-纳塔尔省农村地区男性早期艾滋病毒检测的可接受性：一项混合方法研究。

• 发表时间: 2021
• 影响因子: 1.7
• 作者: Adeagbo, Oluwafemi;Kim, Hae;Tanser, Frank;Xulu, Sibongiseni;Dlamini, Nondumiso;Gumede, Velaphi;Mathenjwa, Thulile;Bärnighausen, Till;McGrath, Nuala;Blandford, Ann;Seeley, Janet;Shahmanesh, Maryam
• 通讯作者: Shahmanesh, Maryam

Managing ancillary care in resource-constrained settings: Dilemmas faced by frontline HIV prevention researchers in a rural area in South Africa.

在资源有限的环境中管理辅助护理：南非农村地区一线艾滋病毒预防研究人员面临的困境。

• 发表时间: 2020-11-09
• 影响因子: 2.5
• 作者: Nkosi, Busisiwe;Seeley, Janet;Chimbindi, Natsayi;Zuma, Thembelihle;Kelley, Maureen;Shahmanesh, Maryam
• 通讯作者: Shahmanesh, Maryam

Persistently high incidence of HIV and poor service uptake in adolescent girls and young women in rural KwaZulu-Natal, South Africa prior to DREAMS.

在 DREAMS 实施之前，南非夸祖鲁-纳塔尔省农村地区的少女和年轻妇女的艾滋病毒发病率持续较高，且服务利用率低下。

• 发表时间: 2018
• 影响因子: 3.7
• 作者: Chimbindi, Natsayi;Mthiyane, Nondumiso;Birdthistle, Isolde;Floyd, Sian;McGrath, Nuala;Pillay, Deenan;Seeley, Janet;Zuma, Thembelihle;Dreyer, Jaco;Gareta, Dickman;Mutevedzi, Tinofa;Fenty, Justin;Herbst, Kobus;Smit, Theresa;Baisley, Kathy;Sha
• 通讯作者: Sha

Beyond interviews and focus groups: a framework for integrating innovative qualitative methods into randomised controlled trials of complex public health interventions.

超越访谈和焦点小组：将创新定性方法整合到复杂公共卫生干预措施的随机对照试验中的框架。

• 发表时间: 2019-06-06
• 影响因子: 2.5
• 作者: Davis, Katy;Minckas, Nicole;Bond, Virginia;Clark, Cari Jo;Colbourn, Tim;Drabble, Sarah J;Hesketh, Therese;Hill, Zelee;Morrison, Joanna;Mweemba, Oliver;Osrin, David;Prost, Audrey;Seeley, Janet;Shahmanesh, Maryam;Spindler, Esther J;Stern, Eri
• 通讯作者: Stern, Eri