Multi-level determinants of uptake and adherence to a novel women-empowered HIV Prevention Strategy.

Due to their biological, social and economic vulnerabilities, adolescent girls and young women (AGYW) continue to be at increased risk for HIV acquisition. We propose an implementation research study to optimize woman-empowered HIV prevention strategies for AGYW. Key to optimizing HIV prevention strategies is an improved understanding of the multilevel determinants (individual, familial, relationship and community-level) of uptake and adherence to HIV prevention strategies targeting AGYW. Funded through a DREAMS Innovation grant, Witkoppen Health and Welfare Centre, a primary health clinic in Johannesburg, South Africa, will enroll HIV-negative AGYW unaware of the HIV status of their sexual partner(s) in an implementation research study. AGYW will be offered free home-based HIV self-testing for their male partners. Interested AGYW will be given HIV test kits and AGYW whose partners test HIV-positive or AGYW who remain unaware of their partner(s) HIV status will be offered pre-exposure prophylaxis (PrEP). The proposed work will build upon the DREAMS Innovation study described above. Using mixed methods, we will evaluate multilevel determinants of uptake and adherence to the novel AGYW-empowered HIV prevention strategy. Quantitative secondary data collected by the DREAMS Innovation study will be complemented with qualitative interviews with AGYW and their male partners at each of the steps of the proposed HIV prevention cascade: AGYW acceptance of self-testing kits for partners; AGYW delivery of self-testing kits to their male partner(s); male partner acceptance of HIV self-testing; disclosure of HIV test results to AGYW; linkage to care of HIV positive male partners; PrEP uptake among eligible AGYW; and PrEP adherence. Our specific aims are as follows: Aim 1: Perform a mixed methods study of multi-level (individual, relationship and community) determinants of uptake of and adherence to each of the steps of the novel AGYW-empowered HIV prevention strategy. Analyses of the DREAMS Innovation cohort data will quantify uptake and adherence to each step, and multi-level modeling will allow for assessment of key determinants of engagement at each step of the prevention cascade. At each step, we will identify 6-8 AGYW and male partners who failed to complete the cascade step and perform in-depth interviews to explore reasons for not completing engagement in HIV prevention activities as well as facilitators of successful engagement in previous steps. Aim 2: Evaluate the impact of engagement in the HIV care cascade on changes in risk profiles among AGYW. Longitudinal changes in AGYW risk profiles will be described and the impact of engagement across the HIV prevention cascade on changes in AGYW risk profiles before and at the end of program participation evaluated.

Keywords:PREVENTION, HIV

Disciplines:Public health care, Public health sciences, Public health services