In South Africa, young people have the highest incidence of HIV infection in the general population. Adolescence is a complex, transitional development phase when behaviors associated with HIV acquisition are often initiated, and it is likely that any current or future HIV prevention strategy will need to be effectively utilized by young people to have an appreciable population-level impact. But despite the importance of HIV prevention efforts among young people, there are few interventions that have demonstrated a significant impact in reducing risk of HIV infection among this group in South Africa and other resource-limited settings. This project will address this gap through a novel approach to combining different HIV prevention strategies into an optimized prevention 'menu'for adolescents, from which young women and men at risk of HIV infection may choose a particular combination of strategies to meet their specific needs and circumstances. Currently there are a number of promising and proven prevention interventions that could potentially constitute a prevention menu of preferred options or combinations, including PrEP, microbicides, HIV Counseling and Testing (HCT) and circumcision. After a systematic review of the literature relating to these and other prevention options, pilot studies will be designed in order to examine key issues of feasibility, acceptability, adherence and sexual behavior change associated with these prevention methods in adolescents. Studies will emulate implementation of services and trials as far as possible in order to address these questions, including ethico-legal issues associated with implementation and delivery, as well as consideration of messaging and social marketing of these approaches to adolescents. Results will be used to inform epidemiological modeling and costing exercises in order to inform how such a prevention 'menu'should be constructed and promoted among young people for maximum benefit. This research will culminate in a separately proposed trial to examine the efficacy of the 'menu'approach in preventing new HIV infections among South African adolescents.

Public Health Relevance

The success of this proposal will provide critical information towards improving HIV prevention efforts among adolescents, both in sub-Saharan Africa and globally. The insights generated will have direct applications in enhancing specific HIV prevention interventions and in the design of a robust trial to evaluate a novel approach to combining biological and behavioral prevention modalities.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
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Special Emphasis Panel (ZAI1-BLG-A (J1))
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Flanagan, Elizabeth H
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Desmond Tutu HIV Foundation
Cape Town
South Africa
Zip Code
Strode, A E; Singh, P P; Slack, C M et al. (2018) Research ethics committees in a tight spot: Approving consent strategies for child research that are prima facie illegal but are ethical in terms of national guidelines. S Afr Med J 108:828-832
Strode, A; Essack, Z (2017) Facilitating access to adolescent sexual and reproductive health services through legislative reform: Lessons from the South African experience. S Afr Med J 107:741-744
Slack, C M; Strode, A E (2016) But is this really the 'parent' or 'guardian'? Practical strategies for consent to child research in South Africa. S Afr J Bioeth Law 9:35-38
Van Rooyen, Heidi Eve; Strode, Ann E; Slack, Catherine M (2016) HIV testing of children is not simple for health providers and researchers: Legal and policy frameworks guidance in South Africa. S Afr Med J 106:37-9
Bhamjee, Suhayfa; Essack, Zaynab; Strode, Ann Elaine (2016) Amendments to the Sexual Offences Act dealing with consensual underage sex: Implications for doctors and researchers. S Afr Med J 106:256-9
Johnson, Leigh F; Chiu, Calvin; Myer, Landon et al. (2016) Prospects for HIV control in South Africa: a model-based analysis. Glob Health Action 9:30314
Bekker, Linda-Gail; Johnson, Leigh; Cowan, Frances et al. (2015) Combination HIV prevention for female sex workers: what is the evidence? Lancet 385:72-87
Bekker, Linda-Gail; Johnson, Leigh; Wallace, Melissa et al. (2015) Building our youth for the future. J Int AIDS Soc 18:20027
Johnson, Leigh F; Rehle, Thomas M; Jooste, Sean et al. (2015) Rates of HIV testing and diagnosis in South Africa: successes and challenges. AIDS 29:1401-9
Strode, Ann Elaine; Slack, Catherine May (2015) Child research in South Africa: How do the new regulations help? S Afr Med J 105:899-900

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