1029- South Africa- Real-time assessment and monitoring of implementation of four PrEP support strategies offered to young women in South Africa

The overarching goal of this implementation research trial is to identify effective approaches and implementation strategies to empower young women at high risk for HIV in South Africa to utilize pre-exposure prophylaxis (PrEP) for HIV prevention during periods of elevated risk for HIV acquisition. PrEP has been prioritized by the South African government, yet evidence of how to implement PrEP scale-up and promote uptake among marginalized young women is lacking. PrEP represents an HIV prevention tool with great promise to finally achieve an AIDS-Free Generation in the country most burdened by HIV, but many young women face a number of structural and interpersonal barriers to achieving consistent PrEP use during periods of risk.
To address these challenges, this project employs a fractional factorial trial design using the MOST Framework to test combinations of four support strategies aimed at encouraging PrEP persistence among marginalized young women. This individual-level factorial trial will compare the existing standardized community engagement model (i.e. PrEP sensitization/promotion and clinical support) to four new support strategies focused on supporting and incentivizing PrEP continuation over a 12-month period in uMgungundlovu, KZN, South Africa. The strategies being tested are as follows: 1) individualized peer case management, 2) peer support buddies, 3) food vouchers provided at PrEP initiation and follow-up visits, and 4) community-based PrEP pickup points. The effects of these strategies (and combinations of strategies) on PrEP persistence among female sex workers (FSW) and adolescent girls and young women (AGYW) will be assessed to identify an optimal package of PrEP support services for future scale up. 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 one of the country’s largest PrEP providers 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 NIH-funded project. The position will be based in Pietermaritzburg within the uMgungundlovu District where the trial will take place. This placement will focus on providing implementation support for the trial and conducting implementation assessments to provide real-time feedback to the study team. The student will also be responsible for evaluating implementation fidelity to identify and address any weaknesses or challenges to allow for real-time adjustments to be made. 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 and 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 applied implementation science skills, experience in pragmatic trials 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 digital health, health communications, social influence, 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 and monitoring and evaluation 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: Sheree Schwartz, Department of Epidemiology, sschwartz@jhu.edu

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

I am supportive, available to provide thoughtful feedback and guidance at any point either in-person, by phone or via email. I work closely with the research and study team to ensure goals are met and individuals are supported to engage at the highest level. We work as a unified team and provide support and mentorship across multiple levels.

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 provided by the study 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.