Optimizing delivery of biomedical HIV prevention for mobile men in fishing communities along Lake Victoria, Kenya

About This Grant

PROJECT SUMMARY/ABSTRACT Across sub-Saharan Africa, approximately one-third of new HIV infections occur among men. Men in highly mobile occupations, such as fishing, are particularly vulnerable to poor HIV prevention engagement. Fisherfolk (men and women who work in the fishing industry) are the largest key/priority population in Kenya. Despite significant declines in HIV incidence in other populations in sub-Saharan Africa, fishermen have persistently high rates of HIV acquisition. Kenya has been a leader in scaling up biomedical HIV prevention, including oral tenofovir-based pre-exposure prophylaxis (PrEP), a daily pill that is highly effective with sufficient adherence. However, efforts to improve daily oral PrEP use have not been effectively deployed to address the unique barriers experienced by mobile fishermen, particularly as new HIV prevention technologies and regimens are introduced such as long-acting injectable PrEP (e.g., CAB-LA; injection every 2 months and lenacapavir; injection every 6 months), event- driven PrEP (oral PrEP taken before and after sexual contact), and post-exposure prophylaxis (oral PrEP taken after potential HIV exposure). Without tailored delivery strategies, these innovations risk reproducing the same access and adherence challenges that have limited the impact of existing prevention tools in this population. Evidence-based approaches tailored to the needs of mobile fishermen are urgently needed to optimize their engagement in biomedical HIV prevention. Evidence-based approaches such as differentiated and patient- centered service delivery for HIV prevention have been endorsed by the WHO, yet these service delivery models have not yet been effectively harnessed to improve mobile fishermen’s uptake and adherence to biomedical HIV prevention. Meaningful engagement of community members in tailoring evidence-based HIV interventions is recognized as an approach that may increase sustainability, ownership, and acceptance of interventions. However, established methods to effectively engage mobile populations, including fishermen, in research are limited. Community-led, participatory approaches in global HIV research have infrequently been utilized with priority populations such as mobile fishermen yet may be vital to addressing prevention gaps. The proposed research uses community-engaged and participatory approaches to identify factors influencing fishermen’s engagement in HIV prevention (Aim 1) and to co-design an evidence-based intervention in collaboration with fishermen (Aim 2). The co-designed intervention will then be piloted to evaluate its implementation and client outcomes (Aim 3). Completion of the proposed training and research plan will provide me with an expanded skillset in community-engaged research, intervention design, and implementation science approaches. I will be mentored by a team of experienced Kenyan and UCSF mentors. A future R01 will evaluate the co-designed intervention at scale.