# Optimizing PrEP implementation and effectiveness among women at high risk for HIV acquisition in South Africa

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2022 · $576,511

## Abstract

Project Summary/Abstract
The goal of this study is to identify effective approaches and implementation strategies to empower young
women at high risk for HIV in South Africa to utilize and persist on pre-exposure prophylaxis (PrEP) for HIV
prevention during periods of elevated risk for HIV acquisition. PrEP uptake remains low among young women
and use by FSW and AGYW halves by 1 month and continues a sharp decline during the first 3-6 months;
effective strategies to target these critical periods are needed. The proposed study is embedded within TB HIV
Care’s large-scale existing PrEP delivery program for young women across 12 sites in South Africa. The
design leverages routinely collected data combined with strategic collection of de novo data and modifications
to the delivery of existing implementation strategies to inform effective PrEP scale-up. Specific Aim 1:
Measure ongoing PrEP implementation (e.g., acceptability, adoption, fidelity, cost) and identify implementation
strategies associated with PrEP uptake and sustained use. Approach: Assess ongoing program
implementation (e.g. direct observation methods, provider assessments, implementation logs) and conduct an
interrupted time-series analysis using existing, program data (2016-2020) and changes to PrEP adherence
interventions introduced over time (e.g. PrEP peer ambassadors, loyalty rewards program, etc.). These data
will be used to identify effective PrEP interventions within the program and to further refine PrEP
implementation strategies. Specific Aim 2: Evaluate the relative effectiveness of modified PrEP
implementation strategies on increasing uptake and sustained PrEP adherence among marginalized
young women. 2a. Approach: Use a cluster randomized design to evaluate the content and reach of PrEP
social influence campaign, and its effect on PrEP uptake and persistence. 2b. Approach: Conduct a cluster
randomized trial focused on modifying implementation strategies of existing peer support interventions to
improve PrEP persistence, by varying the actor, intensity and duration of the implementation strategy. Relative
effectiveness of implementation strategies at achieving 1, 4 and 7-month adherence will be compared and
measured through programmatic PrEP refill data. Specific Aim 3: Identify a set of preferred PrEP
implementation strategies for young women based on the projected population-level HIV prevention
transmission modeling and cost-effectiveness analyses. Approach: We will extend, re-parameterize, and
analyze our previously validated deterministic mathematical model of heterosexual HIV transmission in
Southern Africa, which captures direct and indirect (spillover) prevention benefits of PrEP in the population of
interest (AGYW and FSW) and the wider population. This will quantify the population benefits (infections
inverted) of the PrEP implementation strategies and will include a full economic evaluation.

## Key facts

- **NIH application ID:** 10474342
- **Project number:** 5R01MH121161-03
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Sheree Renae Schwartz
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $576,511
- **Award type:** 5
- **Project period:** 2020-08-14 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10474342

## Citation

> US National Institutes of Health, RePORTER application 10474342, Optimizing PrEP implementation and effectiveness among women at high risk for HIV acquisition in South Africa (5R01MH121161-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10474342. Licensed CC0.

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