Grant: Project Grant

While global incidence of new HIV infections is decreasing, progress toward global prevention targets is lagging. Critical knowledge gaps remain around where to prioritize prevention programs, who to reach, and what prevention services are required to improve population-level outcomes. Using a Program Science approach, the aim of this work is to develop a deeper understanding of how physical, organizational, social and relational dimensions of 'place' shape ecologies of risk and safety for prioritized AGYW (15-24 yrs), FSW, and their male sexual partners (men) in Nairobi County, Kenya. This work will generate contextualized knowledge for prioritizing place-based strategies to optimize STBBI prevention program coverage and address unmet needs. We will use complementary methods, combining primary quantitative (programmatic mapping including venue profiling, and cross-sectional surveys) and qualitative (peer ethnography and field notes) data collection to examine the interconnections between place (Obj 1), people (Obj 2) and programs (Obj 3) that shape ecologies of risk and safety. Data from the three objectives will be integrated and synthesized to collectively address our aim. Building upon well-established prevention programs and partnerships in Nairobi, this research will generate new knowledge to inform the adaptation of existing programs to incorporate place-based strategies for STBBI prevention among AGYW, FSW, and men. Additionally, this work will generate evidence about the overlap and interactions between AGYW, FSW, men and other key population groups (MSM, transgender people, and PWID) in locations across Nairobi to understand the potential relevance of place-based programming for other groups. Reframing programmatic approaches to prioritization to focus on place, rather than individual identities, will be a critical step in improving STBBI-related health outcomes for those most vulnerable and to reduce health inequities at the population level.