Research | Epidemiological | Behavioural
Understanding HIV Prevention Behaviours and Improving Access to Prevention Services
Introduction
Behavioural Research is part of the Epidemiological Research portfolio at the Rakai Health Sciences Program (RHSP). It encompasses research on HIV prevention, access to prevention services and the factors that influence engagement with HIV prevention interventions.
The research portfolio includes the evaluation of HIV prevention programmes, research involving incarcerated populations, home-based pre-exposure prophylaxis (PrEP) care, and the integration of sexually transmitted infection (STI) testing into HIV prevention services.
Ongoing Research
Research Area: Evaluation of HIV prevention interventions.
DREAMS is listed within RHSP's ongoing behavioural research portfolio under the evaluation of HIV prevention effectiveness.
Research Area: HIV among incarcerated populations.
HIV in Incarcerated Persons is included among RHSP's ongoing behavioural research studies.
Home-Based PrEP Care for Rural Female Sex Workers in Uganda
Study Background
HIV prevention medicines such as pre-exposure prophylaxis (PrEP) are highly effective, but accessing and remaining engaged in PrEP care can be challenging for female sex workers living and working in rural communities.
Long distances to health facilities, transport costs, waiting times and concerns about stigma can make it difficult for women to take PrEP consistently, return for refills and remain in prevention care.
The HB-PrEP Study explores whether bringing PrEP services closer to where women live and work can improve adherence and retention in PrEP care.
Study Approach
With support from Gilead Sciences, the study is developing and testing a peer-supported home-based PrEP care model designed to reduce barriers to accessing prevention services among rural female sex workers in Uganda.
The research begins by engaging female sex workers, peer workers and healthcare providers to understand the challenges women face when accessing PrEP services.
Their experiences and perspectives will inform the development of a home-based care model and the procedures needed to implement it.
Study Implementation
The study plans to enrol 50 female sex workers who are using PrEP.
- 25 participants will receive the home-based PrEP care model.
- 25 participants will continue receiving usual facility-based PrEP services.
Trained peer workers will provide selected services closer to participants' communities, including support with PrEP refills, HIV self-testing and urine collection for PrEP-use monitoring.
Participants requiring additional clinical care will continue to be linked to healthcare providers.
Expected Outcomes
Over a 12-month period, the study will assess whether home-based PrEP care is practical, acceptable to women and capable of supporting continued engagement in prevention services.
The findings are expected to provide evidence on whether community-based, peer-supported approaches can reduce barriers to PrEP care and support a more convenient and person-centred HIV prevention model.
Integrated Female Sexually Transmitted Infection Testing for HIV Epidemic Control Through PrEP
Study Background
Sexually transmitted infections (STIs) are a risk factor for HIV acquisition and are used as part of self-risk screening for PrEP eligibility in Uganda.
However, many STI episodes are asymptomatic, meaning women may have an infection without experiencing symptoms. Limited access to laboratory-based STI diagnosis may prevent some women from recognizing their HIV risk or identifying their eligibility for PrEP services.
The INSTEP Study examines whether integrating diagnostic testing for curable STIs into HIV risk screening can improve PrEP use among women in Africa.
Study Design and Implementation
INSTEP is a randomized effectiveness-implementation trial comparing two approaches to identifying women eligible for PrEP.
The study plans to enrol approximately 4,500 HIV-negative women and randomly assign them in equal proportions to:
- Standard self-risk screening for PrEP eligibility, with syndromic STI management.
- Self-risk screening combined with diagnostic testing for curable STIs, including chlamydia, gonorrhoea, trichomoniasis and syphilis.
The study focuses on women aged 15–39 years in the Rakai Community Cohort Study (RCCS).
Study Objectives
Objective 1: Assess PrEP Uptake and Continued Use
Determine whether adding curable STI testing to standard PrEP eligibility screening increases PrEP uptake among women at high risk of HIV.
The study will assess PrEP uptake after screening, adherence and persistence at six months using surveys, clinical records and drug-level testing.
Objective 2: Evaluate Implementation
Use qualitative and quantitative research methods to examine the mechanisms, barriers and facilitators influencing the integration of STI testing into HIV prevention services.
Objective 3: Inform Population-Level Prevention Strategies
Use study findings to develop mathematical models assessing efficient approaches to STI testing and their potential contribution to reducing HIV incidence.
Expected Contribution
The INSTEP Study seeks to generate effectiveness, implementation and modelling evidence to guide decisions about integrating STI diagnosis into HIV prevention programmes.
The findings will help inform how curable STI testing could be incorporated into PrEP eligibility screening and service delivery for women in African settings.
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