Community-led delivery of HIV self-testing to improve HIV testing, ART initiation and broader social outcomes in rural Malawi: study protocol for a cluster-randomised trial
Community-led delivery of HIV self-testing to improve HIV testing, ART initiation and broader social outcomes in rural Malawi: study protocol for a cluster-randomised trial
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DOI：
10.1186/s12879-019-4430-4
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发表时间：
2019-09-18
影响因子：
3.7
通讯作者：
Corbett, Elizabeth L.
中科院分区：
文献类型：
--
作者：
Indravudh, Pitchaya P.;Fielding, Katherine;Corbett, Elizabeth L.
背景 预防新的艾滋病毒感染是一个重要的公共卫生问题。 HIV 检测差距最大的是男性、15-19 岁的青少年以及 40 岁及以上的成年人。基于社区的艾滋病毒检测服务 (HTS) 有助于提高检测覆盖率和早期艾滋病毒诊断，而艾滋病毒自我检测 (HIVST) 策略显示出前景。然而，基于社区的战略是资源密集型、成本高昂且未得到广泛实施。以社区为主导的健康干预方法包括支持社区规划和实施改善健康的解决方案。该试验旨在确定社区主导的 HIVST 实施是否可以提高马拉维农村地区 HIV 检测的采用率、ART 的启动以及更广泛的社会成果。方法 该试验采用平行臂、整群随机设计，村长 (GVH) 及其定义的服务区域随机 (1:1) 接受社区主导的 HIVST 或继续标准护理 (SOC)。作为干预措施的一部分，支持非正式社区卫生干部计划和实施与艾滋病毒治疗和预防相关的为期 7 天的 HIVST 运动。初次活动后大约 12 个月，干预 GVH 被随机分配领导重复的 HIVST 活动。主要结果包括 15-19 岁青少年一生中接受过 HIV 检测的比例。次要结果包括最近对 40 岁及以上成年人和男性进行的测试； ART启动；艾滋病毒预防知识；和艾滋病毒检测的耻辱。结果将通过横断面调查和诊所登记来衡量。经济评估将确定每人检测的成本、每人诊断的成本以及增量成本效益比。讨论 据我们所知，这是第一个评估社区主导的 HTS 有效性的试验，该试验最近才通过 HIVST 的引入才得以实现。由社区主导的艾滋病毒检测是一项很有前途的新战略，可提供定期艾滋病毒检测，以支持农村社区的艾滋病毒预防。此外，通过社区主导的框架引入 HIVST 似乎特别合适，同时将医疗保健的控制权下放给个人和社区。
Background Prevention of new HIV infections is a critical public health issue. The highest HIV testing gaps are in men, adolescents 15-19 years old, and adults 40 years and older. Community-based HIV testing services (HTS) can contribute to increased testing coverage and early HIV diagnosis, with HIV self-testing (HIVST) strategies showing promise. Community-based strategies, however, are resource intensive, costly and not widely implemented. A community-led approach to health interventions involves supporting communities to plan and implement solutions to improve their health. This trial aims to determine if community-led delivery of HIVST can improve HIV testing uptake, ART initiation, and broader social outcomes in rural Malawi. Methods The trial uses a parallel arm, cluster-randomised design with group village heads (GVH) and their defined catchment areas randomised (1:1) to community-led HIVST or continue with the standard of the care (SOC). As part of the intervention, informal community health cadres are supported to plan and implement a seven-day HIVST campaign linked to HIV treatment and prevention. Approximately 12 months after the initial campaign, intervention GVHs are randomised to lead a repeat HIVST campaign. The primary outcome includes the proportion of adolescents 15-19 years old who have tested for HIV in their lifetime. Secondary outcomes include recent testing in adults 40 years and older and men; ART initiation; knowledge of HIV prevention; and HIV testing stigma. Outcomes will be measured through cross-sectional surveys and clinic registers. Economic evaluation will determine the cost per person tested, cost per person diagnosed, and incremental cost effectiveness ratio. Discussion To the best of our knowledge, this is the first trial to assess the effectiveness of community-led HTS, which has only recently been enabled by the introduction of HIVST. Community-led delivery of HIVST is a promising new strategy for providing periodic HIV testing to support HIV prevention in rural communities. Further, introduction of HIVST through a community-led framework seems particularly apt, with control over healthcare concurrently devolved to individuals and communities.