Implementing Assisted Partner Services to HIV Test and Treat Men in Western Kenya

据估计，超过50%的肯尼亚艾滋病毒感染者不知道自己的状况，男性的比例要低得多。 可能会测试和链接到照顾比妇女。除非更多的注意力集中在男性身上，否则肯尼亚和其他亚- 艾滋病毒流行率高的撒哈拉非洲国家到2020年将无法实现艾滋病规划署的90-90-90目标。这 建议解决艾滋病毒检测的低吸收率以及与护理和治疗服务的联系薄弱的问题， 撒哈拉以南非洲的男性。总体目标是使用实施科学方法进行演示 协助伴侣服务（aPS）是一种安全有效的策略，可以增加男性生活在 艾滋病毒感染者知道自己的血清状况，艾滋病预防系统将提高男性参与艾滋病毒治疗计划的程度。 这项研究将在肯尼亚艾滋病毒流行率最高的两个县进行：荷马湾 (27%患病率）和基苏穆（18.7%患病率），并由经验丰富的协作人员进行 该团队在艾滋病毒伴侣检测研究和实施科学方面有着非常出色的记录， 肯尼亚.首席研究员Carey Farquhar（华盛顿大学[UW]）将与一位 来自华盛顿大学、PATH、肯尼亚卫生部和 国家艾滋病和性传播感染控制计划（NASCOP），并建立在一个成功的随机临床试验， 辅助合作伙伴服务（aPS）由UW和NASCOP从2012-2015进行。拟议的研究还 利用PATH在政府设施中提供艾滋病毒检测和治疗的丰富经验， APHIAplus方案以及适宜卫生技术组织最近为21 000多名少女和年轻妇女绘制的地图， 作为肯尼亚西部梦想计划的一部分。具体目标如下： 目标1：通过证明aPS改善HIV检测，识别新的HIV， 感染，并在实施时促进男性伴侣之间的联系、治疗和病毒抑制 在肯尼亚政府设施中的妇女和少女。 目标2：评估在38 APHIAPlas实施aPS时的保真度、可行性和成本/成本效益 在肯尼亚西部，DREAMS倡议建立了9个“安全空间”。使用混合 在这种现实世界的环境中，我们将获得对国家和区域规模扩大至关重要的数据。 就目标1而言，我们将为8，000多名感染艾滋病毒的少女和妇女及其所有男性提供艾滋病毒预防服务。 如果男性伴侣感染了艾滋病毒，还将向其女性伴侣提供艾滋病毒预防服务。目标2： 使用定量和定性的方法，收集和评估来自高风险设施子集的数据 和低绩效者，确定在实施层面上的“必要”要素，并进行一次 可行性研究，包括可接受性、整合性、需求、技术效率和成本数据分析。在 通过这种方式，华盛顿大学/适宜卫生技术/卫生部小组将努力建设肯尼亚的能力， 维持一个可在撒哈拉以南非洲推广的示范性的援助和支助方案。

It is estimated that >50% of HIV-infected Kenyans are unaware of their status and men are significantly less likely to test and link to care than women. Unless more attention is focused on men, Kenya and other sub- Saharan African countries with high HIV prevalence will not achieve UNAIDS 90-90-90 goals by 2020. This proposal addresses low uptake of HIV testing and poor linkage to care and treatment services among men in sub-Saharan Africa. The overarching goal is to demonstrate using implementation science methods that assisted partner services (aPS) is a safe and effective strategy to increase the proportion of men living with HIV who know their serostatus and that aPS will improve male engagement in HIV treatment programs. The study will be based in two counties in Kenya with the highest HIV prevalence in the nation: Homa Bay (27% prevalence) and Kisumu (18.7% prevalence) and be conducted by an experienced and collaborative team with an exceptionally strong track record in HIV partner testing research and implementation science in Kenya. Principal Investigator Carey Farquhar (University of Washington [UW]) will work closely with a multidisciplinary group of investigators and consultants from UW, PATH, Kenya's Ministry of Health, and the National AIDS and STI Control Program (NASCOP), and build on a successful randomized clinical trial of assisted partner services (aPS) conducted by UW and NASCOP from 2012-2015. The proposed research also leverages PATH's vast experience providing HIV testing and treatment in government facilities through the APHIAplus program, as well as PATH's recent mapping of >21,000 adolescent girls and young women for services as part of the DREAMS initiative in western Kenya. The specific aims are as follows:  AIM 1: Determine aPS effectiveness by demonstrating that aPS improves HIV testing, identifies new HIV infections, and promotes linkage, treatment and viral suppression among male partners when implemented among women and adolescent girls in government facilities in Kenya.  AIM 2: Evaluate fidelity, feasibility, and cost/cost-effectiveness when implementing aPS at 38 APHIAplus facilities and 9 “safe spaces” established by the DREAMS initiative in western Kenya. Using a mixed methods approach in this real-world setting, we will obtain data critical to national and regional scale-up. For Aim 1, we will offer aPS to more than 8,000 HIV-infected adolescent girls and women and all of their male partners; if a male partner is HIV-infected aPS will also be offered to his female partners. For Aim 2, we will use quantitative and qualitative methods to collect and evaluate data from a subset of facilities that are high and low performers, determine “necessary” elements of aPS at the level of implementation, and conduct a feasibility study, including analyses of acceptability, integration, demand, technical efficiency and cost data. In this way, the UW/PATH/MOH team will work towards building capacity in Kenya to effectively implement and sustain a model aPS program that could be replicated across sub-Saharan Africa.