Innovative strategies to increase ART Initiation and viral suppression among HIV+ men in Malawi

项目摘要 艾滋病毒检测和治疗服务继续遗漏男性。索引合作伙伴测试是以下方面的关键战略 接触到男人。指标HIV自我检测(HIVST)，即抗逆转录病毒治疗客户将HIVST试剂盒带回家给他们的性伴侣 对于测试，这是一种新的战略，大大增加了男性的指数测试，并正在被规模化 在马拉维各地。然而，在通过Index HIVST确定为HIV阳性的男性中，只有25%在6岁后开始抗逆转录病毒治疗 月份。迫切需要创新的战略，以增加男性的艺术启蒙和留存。这个 建议的K01的总体目标是开发和试点基于家庭的艺术干预(ART启蒙+ 3个月的抗逆转录病毒治疗)，以增加抗逆转录病毒治疗的启动(主要结果)和6个月的病毒抑制(次要结果 结果)在马拉维通过指数HIVST检测艾滋病毒呈阳性的男性中。候选人：我是一名社会科学家 在撒哈拉以南非洲从事艾滋病毒研究的背景。我的长期目标是从观察型 社会科学到临床试验研究在难以企及的艾滋病毒服务提供模式中创新 人口，如男性。我正在申请为期五年的K01奖项，以获得培训、指导和研究 经验。指导：我有一支出色的多学科指导团队，在以下方面拥有丰富的经验 该区域的艾滋病毒护理和管理以及临床试验。该团队在社交领域拥有互补的专业知识 艾滋病毒服务提供模式的科学和临床试验(Thomas Coates博士--主要导师)，最佳做法 马拉维艾滋病毒护理和管理以及差异化护理模式(朱迪思·柯里尔博士和丽莎·霍夫曼博士)， 干预措施的可扩展性和可持续性(桑迪普·古普塔博士，马拉维)，以及高级生物统计 (罗恩·布鲁克迈尔博士)职业发展：为了实现我的长期目标，我们制定了一个详细的计划 培养四个额外领域的技能：(1)抗逆转录病毒治疗和维护的最佳临床实践；(2)临床试验 提供艾滋病毒服务的新方法；(3)先进的统计方法；(4)临床试验中的伦理 在资源匮乏的环境下进行研究。研究活动：伴随职业生涯的具体目标 发展计划是：(1)通过Index测试，为男性伴侣开发基于家庭的艺术干预 HIVST，使用对男性指数HIVST用户(n=15-20)及其合作伙伴(n=15-20)的深入访谈，并关注 与主要信息提供人进行小组讨论(n=18-30)。(2)确定居家艺术的潜在有效性 对比基于标准设施的抗逆转录病毒疗法(抗逆转录病毒疗法启动(主要结果)和6个月的病毒抑制 (次要结果)在男性指数HIVST使用者中，对200名艾滋病毒阳性男性进行了试点试验。预期 结果：这项研究的结果将为最终试验提供信息，以测试针对已确定身份的男性的基于家庭的ART服务 通过索引HIVST策略确定为HIV阳性。该项目还将给我所需的额外技能集 成为临床试验的独立研究员。

Project Summary Men continue to be missed by HIV testing and treatment services. Index partner testing is a critical strategy for reaching men. Index HIV self-testing (HIVST), whereby ART clients take HIVST kits home to their sexual partners for testing, is a new strategy that dramatically increases index testing among men, and is being taken to scale across Malawi. However, only 25% of men identified as HIV-positive through Index HIVST initiate ART after 6- months. Innovative strategies to increase ART initiation and retention among men are urgently needed. The overarching goal of the proposed K01 is to develop and pilot a home-based ART intervention (ART initiation + 3-months ART care) to increase ART initiation (primary outcome) and 6-month viral suppression (secondary outcome) among men who test HIV-positive through Index HIVST in Malawi. Candidate: I am a social scientist with a background in HIV research in sub-Saharan Africa. My long-term goal is to transition from observational social science to clinical trials research in innovative HIV service delivery models among hard-to-reach populations, such as men. I am applying for a five-year K01 award to obtain training, mentorship, and research experience. Mentoring: I have an exceptional multi-disciplinary mentoring team with extensive experience in HIV care and management and clinical trials in the region. The team has complementary expertise in social science and clinical trials in HIV service delivery models (Dr. Thomas Coates – Primary Mentor), best practices in HIV care and management and differentiated models of care in Malawi (Drs. Judith Currier and Risa Hoffman), scalability and sustainability of interventions (Dr. Sundeep Gupta – Malawi-based), and advanced biostatistics (Dr. Ron Brookmyer). Career Development: To achieve my long-term goals, we have developed a detail plan to build skills in four additional areas: (1) best clinical practices for ART care and maintenance; (2) clinical trials in novel approaches to HIV service delivery; (3) advanced statistical methods; and (4) ethics in clinical trials research in low-resource settings. Research Activities: The specific aims accompanying the career development plan are to: (1) Develop a home-based ART intervention for male partners tested through Index HIVST, using in-depth interviews with male Index HIVST users (n=15-20) and their partners (n=15-20), and focus group discussions with key informants (n=18-30). (2) Determine the potential effectiveness of home-based ART versus standard facility-based ART (on ART initiation (primary outcome) and 6-month viral suppression (secondary outcome) among male Index HIVST users in a pilot trial with 200 HIV-positive men. Expected Outcomes: Results from this study will inform definitive trial to test home-based ART services for men identified as HIV-positive through index HIVST strategies. The project will also give me the additional skillsets needed to become an independent investigator in clinical trials.