Gender-Specific Combination HIV Prevention for Youth in High-Burden Settings: The MP3 Youth Observational Pilot Study Protocol

Abstract

BackgroundNearly three decades into the epidemic, sub-Saharan Africa (SSA) remains the region most heavily affected by human immunodeficiency virus (HIV), with nearly 70% of the 34 million people living with HIV globally residing in the region. In SSA, female and male youth (15 to 24 years) are at a disproportionately high risk of HIV infection compared to adults. As such, there is a need to target HIV prevention strategies to youth and to tailor them to a gender-specific context. This protocol describes the process for the multi-staged approach in the design of the MP3 Youth pilot study, a gender-specific, combination, HIV prevention intervention for youth in Kenya.ObjectiveThe objective of this multi-method protocol is to outline a rigorous and replicable methodology for a gender-specific combination HIV prevention pilot study for youth in high-burden settings, illustrating the triangulated methods undertaken to ensure that age, sex, and context are integral in the design of the intervention.MethodsThe mixed-methods, cross-sectional, longitudinal cohort pilot study protocol was developed by first conducting a systematic review of the literature, which shaped focus group discussions around prevention package and delivery options, and that also informed age- and sex- stratified mathematical modeling. The review, qualitative data, and mathematical modeling created a triangulated evidence base of interventions to be included in the pilot study protocol. To design the pilot study protocol, we convened an expert panel to select HIV prevention interventions effective for youth in SSA, which will be offered in a mobile health setting. The goal of the pilot study implementation and evaluation is to apply lessons learned to more effective HIV prevention evidence and programming.ResultsThe combination HIV prevention package in this protocol includes (1) offering HIV testing and counseling for all youth; (2) voluntary medical circumcision and condoms for males; (3) pre-exposure prophylaxis (PrEP), conditional cash transfer (CCT), and contraceptives for females; and (4) referrals for HIV care among those identified as HIV-positive. The combination package platform selected is mobile health teams in an integrated services delivery model. A cross-sectional analysis will be conducted to determine the uptake of the interventions. To determine long-term impact, the protocol outlines enrolling selected participants in mutually exclusive longitudinal cohorts (HIV-positive, PrEP, CCT, and HIV-negative) followed by using mobile phone text messages (short message service, SMS) and in-person surveys to prospectively assess prevention method uptake, adherence, and risk compensation behaviors. Cross-sectional and sub-cohort analyses will be conducted to determine intervention packages uptake.ConclusionsThe literature review, focus groups, and modeling indicate that offering age- and gender- specific combination HIV prevention interventions that include biomedical, behavioral, and structural interventions can have an impact on HIV risk r...

Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review

“…Five studies used a pre/post design,36 41–45 and one reported baseline data from a pre/post study 46. Two studies used a cohort study design,47 48 and two used a cross-sectional design with statistical matching 19 49…”

“…The included studies described similar biomedical components that included HIV testing and counselling, condom distribution and linkages to other health services. Unique components included PrEP delivered to youths through mobile health events and voluntary medical male circumcision and family planning 47…”

“…Structural interventions were more varied but generally included community-wide awareness raising and capacity building components, sensitivity training for stakeholders and support network strengthening activities, and stigma and discrimination reduction activities. Two programmes included microcredit in the forms of a conditional cash transfer and a microfinance with matched-savings programme,40 47 one provided support to access social security grants48 and three programmes offered legal service assistance/support 19 40 44. One programme relied on mass media training in its interventions 19.…”

“…Other traditional prevention outcomes measures included HIV and STI incidence/rate, testing and treatment, knowledge about HIV and treatment, and prevention adherence. Only one study measured male circumcision and contraceptive use 47…”

“…Very few empowerment outcomes were repeated between studies. Four studies did not measure empowerment outcomes at all 42 44 47 49. Two studies reported measuring MSM sexual orientation disclosure status,19 45 and two studies reported measuring HIV disclosure status 39 43.…”