[R01] Determining the impact of peer-led, community-based PrEP delivery among youth in Brazil: A randomized controlled trial
Ente: National Institute of Mental Health
Scadenza: 2029-04-30
Importo max: 248.765 EUR
Paese: US
Descrizione
Despite significant global progress, efforts to reduce HIV incidence by 90% from 2010 to 2030 are lagging and uneven. In the United States, HIV incidence per 100,000 declined from 15.3 in 2000 to 11.3 in 2023. Yet, the United States experiences more than 30,000 new HIV infections each year, and 1 in 5 occur among youth aged 13-24 years. Of people in the United States who received HIV pre-exposure prophylaxis (PrEP) in 2023, only 11% were youth. Similarly in Brazil, youth are the primary driver of the HIV epidemic but comprise <1% of people who receive PrEP. Our team conducted the first and largest PrEP demonstration study among adolescents in Latin America (PrEP1519), in which we implemented peer navigation strategies that linked 1174 youth (20% of 5870 recruited) to PrEP services at health facilities. In qualitative interviews, youth articulated positive relationships with peer navigators but reluctance to engage with facility-based services due to past experiences with stigma and logistical and structural challenges accessing care. These data suggest that programs featuring peers were welcomed, but alternatives to facility-based services are urgently needed to scale up PrEP among youth. We hypothesize that equipping peer lay workers – trained youth who are integrated into health care teams – to deliver PrEP in community venues will increase PrEP uptake among youth. The goal of this project is to conduct a series of studies to refine, test, and understand experiences with a peer-led community-based intervention (CommunityPrEP, “COMPrEP”). In Aim 1, we will conduct qualitative interviews guided by the Consolidated Framework for Implementation Research to identify key modifications for the PrEP1519 peer navigator intervention to adapt it for community delivery by peer lay workers. In Aim 2, we will randomize 1400 youth who can benefit from PrEP to access PrEP through peer lay workers at community venues (COMPrEP intervention) or health providers at health facilities (standard care). We will conduct intent-to-treat analyses with modified Poisson regression to compare PrEP uptake (primary outcome) across randomized arms. We will follow the subset that initiates PrEP (expected to be N~385) for 13 months to compare secondary outcomes (1-month adherence, 4-month and 13-month persistence). Throughout the trial, we will monitor participant safety through our study team and an external monitoring board. In Aim 3, we will use the RE-AIM framework to explore experiences with the COMPrEP intervention through qualitative interviews with youth, peer lay workers and health providers, and local and national policymakers to develop next steps. This project will generate objective evidence about whether PrEP delivery facilitated by peer lay workers in community settings increases PrEP uptake, adherence, and persistence among youth. Findings will address a critical evidence gap in PrEP implementation research by producing some of the first empirical data on the rol
Istituzione: UNIVERSITY OF ALABAMA AT BIRMINGHAM
PI: Katia Bruxvoort
Progetto: 3R01MH135769-03S2
Settori: National Institute of Mental Health
Vai al bando originale
Registrati gratis su Bandolo per trovare bandi compatibili con la tua azienda.