1021- South Africa- Optimizing PrEP implementation and effectiveness among women at high risk for HIV acquisition in South Africa through a fractional factorial trial

This study utilizes the MOST (Multiphase Optimization Strategy) Framework to identify and test strategies to support pre-exposure prophylaxis (PrEP) uptake and persistence among young women at high risk for HIV in South Africa. Given the substantial individual, social, and structural barriers to PrEP use that marginalized young women experience, we aim to evaluate the relative effectiveness of various permutations of four PrEP support strategies on increasing PrEP uptake among marginalized young women. Specifically, we will test case management, food vouchers, peer support buddies, and community-based PrEP pickup points to identify an optimized package of support strategies for future scale up. The effects of these modifications on PrEP persistence are being tested using a short-duration, individual-level fractional factorial trial which allows for testing and comparison of all possible combinations of the four strategies to identify an optimal package. The trial is embedded within the current programmatic infrastructure at TB HIV Care (THC). THC is a South African non-profit organization that works directly with the Department of Health as the country’s largest PrEP provider for adolescent girls and young women (AGYW) and female sex workers (FSW) and is implementing this work.

The student will work collaboratively with partners on this exciting project funded by the NIH. The position will be based in Pietermaritzburg in the uMgungundlovu District where the trial will take place. This placement will focus on directly supporting implementation of the factorial trial in partnership with TB HIV Care and their local research team. Specifically, the student will support with management of data collection activities, recruitment, enrollment, and randomization to ensure implementation runs smoothly. The student will also support with quality control checks and management of study visit and intervention schedules to ensure activities are completed on schedule. This project offers an intersection of professional and academic opportunities that is an integral opportunity to gain critical skills in development and management of a randomized control trial, hands-on experience with study implementation, as well as experience working on an implementation science study in a middle-income country. If able to travel, working in the field with local counterparts gives the applicant the opportunity to develop skills in study management that will help them critically analyze how they would design future projects. This study is a good fit for someone aiming to gain clinical trials experience, implementation science experience and advance their quantitative and qualitative skillset.

The professional work environment at the site is positive and fosters productivity across team members, study and program staff. The workplace operates in a mature, respectful matter and collaboration and teamwork occurs across the study and program staff at TB HIV Care. The research team – both at the TB HIV Care site and here at Johns Hopkins – is supportive, unified, and communicative.

This placement would be a good fit for someone who is motivated and can take the lead on projects. Regular mentoring and supervision will be provided by investigators in South Africa and the US, however it will be the responsibility of the student to use the ideas and advice provided by the investigative team to move aspects of the project along, requesting additional support along the way when needed. Students with an interest in innovative trial designs, implementation science, and working with key populations are encouraged to apply.

Epidemiology and biostats (620 series or above preferred); completion of qualitative series; courses in implementation science a plus, but not required.

Experience working with marginalized populations and on sensitive topics preferred.
A minimum of 20 weeks is required unless COVID-19 related travel restrictions prohibit this duration, although students who wish to stay longer are encouraged to do so and expenses will be covered to support this. Students who continue to work with the project for longer than 20 weeks will likely have more of an opportunity to assist with data analysis and manuscript development.

Name: Lily Shipp, Department of Epidemiology, lshipp2@jhu.edu

I would describe my communication and mentorship styles as... 

I am open, always available, and constantly in communication with students and in-country team members. I work closely with the research and study team on a day-to-day basis to coordinate study activities and ensure all team members feel fully engaged in the work. Our teams at JHU and TB HIV Care have a long-standing partnership and all team members work together to ensure students feel supported.

A complementary student would have a working style and mentorship expectations that are..

A complementary student will be interested in the work, hardworking, and able to work independently and collaboratively. We are looking for students that are excited about the work, willing to learn, and interested in integrating within TB HIV Care and research team. Students who do well with a hands-on mentorship style while also being able to take initiative and ownership of their responsibilities within the project will be a good fit for this placement.

The monthly stipend is sufficient to cover housing, food and use of public transport if able to safely travel due to COVID-19. Students wishing to travel internally for personal reasons may incur out of pocket expenses.

We will work with the student to develop a budget to cover monthly expenses including housing, transportation, groceries, and other basic living expenses. Any living expenses not covered by the GHEFP grant will be covered by the project. Flights to and from South Africa will be covered by the project.