Shikamana PrEP: A Community Participatory Approach to Integrating PrEP, Sexual Health, and Mental Health Services for GBMSM in Kenya

Shikamana PrEP：肯尼亚 GBMSM 整合 PrEP、性健康和心理健康服务的社区参与方法

• 批准号: 10064644
• 负责人: Susan Marie Graham
• 金额: $ 20.22万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064644
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adoption; Africa; African; Age-Years; Anti-Retroviral Agents; Area; Awareness; Behavior Therapy; Behavioral; Behavioral Sciences; Bisexual; Caring; Case Management; Centers for Disease Control and Prevention (U.S.); Charge; Cities; Clinic; Clinical Trials; Cohort Studies; Collaborations; Communities; Continuity of Patient Care; Counseling; Decision Making; Discrimination; Enrollment; Ensure; Epidemiologist; Feedback; Female; Fostering; Gays; General Population; HIV; HIV Seronegativity; HIV Seropositivity; HIV risk; HIV-1; Health Personnel; Health Promotion; Health protection; Homophobia; Human immunodeficiency virus test; Information Services; Infrastructure; Intervention; Kenya; Leadership; Lesbian Gay Bisexual Transgender Intersex; Mental Health; Mental Health Services; Michigan; Modeling; Outcome; Pharmaceutical Preparations; Plasma; Population; Prevalence; Production; Provider; Public Health; Randomized Controlled Trials; Recommendation; Recording of previous events; Reporting; Reproductive Health; Research; Resources; Rights; Risk; Risk Reduction; Safety; Scientist; Sexual Health; Societies; Testing; Training; United States National Institutes of Health; Universities; Viral; Viral Load result; Vulnerable Populations; Washington; Work; World Health Organization; acceptability and feasibility; antiretroviral therapy; base; cohort; design; early experience; experience; follow-up; high risk men; marginalized population; men; men who have sex with men; motivational enhancement therapy; multi-component intervention; multidisciplinary; peer; peer support; pre-exposure prophylaxis; prevention service; programs; prospective; resilience; scale up; sex; sexual health intervention; social stigma; standard of care; success; theories; therapy adherence; therapy design; uptake; virology

Project Summary Gay, bisexual, and other men who have sex with men (GBMSM) are at high risk for HIV-1 acquisition, especially in rights-constrained settings such as Kenya, where men's access to HIV prevention has been impeded by homophobia, stigma, and discrimination. Pre-exposure prophylaxis (PrEP) has the potential to greatly reduce HIV acquisition risk in this key population, if accessible, sustainable PrEP programming with tailored, effective adherence support can be provided. To this end, close collaboration between PrEP program implementers and GBMSM-led community-based organizations is essential. In this R34 application, we propose (1) to identify multi-level barriers and facilitators that influence GBMSM's ability to engage in the PrEP continuum of care by examining socioecological factors that impact Kenyan GBMSM's lives, including sexual and PrEP-related stigma, sexual health promotion, and resilience, through qualitative work with PrEP- experienced and PrEP-naïve GBMSM and peers engaged in HIV testing/counseling or PrEP programming; (2) to adapt and enhance a theory-based and culturally relevant PrEP support intervention called Shikamana PrEP that includes peer navigation and integrated “Next Step Counseling” to promote sexual health protection strategies, including PrEP uptake and adherence, among GBMSM in Kisumu, following steps 1-6 of the ADAPT-ITT model (assessment, decision-making, adaptation, production, expert review, and integration of feedback) in collaboration with our GBMSM community partners; and (3) to determine the acceptability, feasibility, and safety of the Shikamana PrEP intervention and estimate initial effect size compared to standard of care on PrEP uptake and adherence assessed by drug levels over 6 months in a pilot randomized controlled trial. This proposal builds on the success of the Shikamana study, which developed a provider and peer support intervention that successfully increased the odds of plasma viral load suppression among HIV-positive GBMSM taking antiretroviral therapy, and the Anza Mapema project, which enrolled over 600 HIV-negative GBMSM in Kisumu for 12 months of follow-up in HIV prevention services and is currently following a PrEP cohort of 167 men for 12 months. Our experienced, productive multidisciplinary team of collaborators from the University of Washington, University of Michigan, and the Nyanza Reproductive Health Society, has expertise in the fields of HIV prevention and care (Drs. Graham, Otieno, and Bailey) and behavioral science and intervention design (Drs. Graham, Harper, Amico, and Simoni), and has partnered for this research with the NYARWEK Network of 23 community-based LGBTI organizations in the study area. We anticipate that results of the proposed research will have high impact by ensuring GBMSM involvement in the scale-up of effective PrEP programming for this key population in Kenya and providing a peer-led PrEP support model for GBMSM and other vulnerable and marginalized populations in African settings.

项目概要 同性恋、双性恋和其他男男性行为者 (GBMSM) 感染 HIV-1 的风险很高， 尤其是在肯尼亚等权利受到限制的环境中，男性获得艾滋病毒预防的机会一直受到限制 暴露前预防 (PrEP) 有可能因恐同、耻辱和歧视而受到阻碍。 如果可以获得可持续的 PrEP 规划，可大大降低这一重点人群的 HIV 感染风险 为此，PrEP 计划之间的密切合作可以提供量身定制的、有效的依从性支持。 实施者和 GBMSM 领导的社区组织至关重要。在这个 R34 应用程序中，我们。 建议 (1) 确定影响 GBMSM 参与 PrEP 能力的多层次障碍和促进因素 通过检查影响肯尼亚 GBMSM 生活的社会生态因素（包括性）来提供连续护理 以及与 PrEP 相关的耻辱、性健康促进和复原力，通过 PrEP 的定性工作 经验丰富且未接触过 PrEP 的 GBMSM 以及从事 HIV 检测/咨询或 PrEP 规划的同行 (2) 适应和加强基于理论和文化相关的 PrEP 支持干预措施，称为 Shikamana PrEP 包括同伴导航和综合“下一步咨询”，以促进性健康保护 基苏木 GBMSM 中的策略，包括 PrEP 的采用和坚持，遵循《指南》的步骤 1-6 ADAPT-ITT模型（评估、决策、适应、制作、专家评审、整合 反馈）与我们的 GBMSM 社区合作伙伴合作；以及 (3) 确定可接受性， Shikamana PrEP 干预的可行性和安全性，并与标准相比估计初始效果大小 在一项随机对照试验中，通过 6 个月以上的药物水平评估 PrEP 摄取和依从性的护理 该提案建立在 Shikamana 研究的成功基础上，该研究开发了提供者和同行。 支持干预措施成功增加了艾滋病毒阳性者血浆病毒载量抑制的几率 GBMSM 接受抗逆转录病毒治疗，以及 Anza Mapema 项目，该项目招募了 600 多名艾滋病毒阴性者 GBMSM 在基苏木进行了 12 个月的艾滋病毒预防服务随访，目前正在进行 PrEP 我们的团队由 167 名男性组成，历时 12 个月。 华盛顿大学、密歇根大学和尼安萨生殖健康协会拥有专业知识 在艾滋病毒预防和护理领域（格雷厄姆博士、奥蒂诺博士和贝利博士）以及行为科学和 干预设计（Graham、Harper、Amico 和 Simoni 博士），并与 NYARWEK 由研究区域内 23 个社区 LGBTI 组织组成的网络 我们预计会出现这样的结果。 通过确保 GBMSM 参与扩大有效性，拟议研究的一部分将产生重大影响 针对肯尼亚这一关键人群进行 PrEP 规划，并为 GBMSM 提供同行主导的 PrEP 支持模型 以及非洲地区的其他弱势和边缘化人群。

项目成果

"God Didn't Make a Mistake in Creating Me": Intrapersonal Resilience Processes among Gay and Bisexual Male Youth in Kenya.

“上帝在创造我时没有犯错误”：肯尼亚同性恋和双性恋男性青年的内心复原力过程。

• 发表时间: 2021-09
• 作者: Harper, Gary W;Lewis, Katherine A;Norwitz, Gabriella A;Odhiambo, Elijah Ochieng;Jadwin;Okutah, Feli;Lauber, Kendall;Aloo, Teddy;Collins, Ben;Gumbe, Edwin;Amico, K Rivet;Olango, Kennedy;Odero, Wilson;Graham, Susan M
• 通讯作者: Graham, Susan M