Engaging men through HIV self-test and differentiated care models to increase ART initiation and viral suppression in Malawi

项目摘要 男子仍然得不到艾滋病毒检测和治疗服务。索引合作伙伴测试是 到达男人。索引艾滋病毒自我检测（HIVST），即抗逆转录病毒疗法的客户将HIVST试剂盒带回家给他们的性伴侣 是一项新的战略，它大大增加了男性的指数测试，并正在扩大规模。 穿越马拉维然而，只有25%的通过指数HIVST确定为艾滋病毒阳性的男性在6- 10岁后开始抗逆转录病毒治疗。 个月迫切需要采取创新战略，增加男性接受抗逆转录病毒疗法的人数和保留率。的 建议的R 01的总体目标是测试以家庭为基础的ART干预（ART启动+3个月ART 护理）加上动机性访谈，以增加ART的启动和6个月的病毒抑制的男性， 通过马拉维的艾滋病毒检测指数检测艾滋病毒呈阳性。具体目的是：（1）检验家庭式教学的有效性 与基于机构的ART相比，在接受ART启动和6个月病毒抑制的男性伴侣中， 指数HIVST;（2）确定ART启动和6个月病毒抑制的预测因素;（3）确定成本 和成本效益的家庭为基础的抗逆转录病毒疗法与设施为基础的男性合作伙伴使用指数艾滋病毒/艾滋病。的 试验将为难以接触的人群提供关于创新艾滋病毒服务提供战略的紧急信息， 例如男人。预计调查结果将为国家政策和国际建议提供信息， 将差异化的模式结合起来，覆盖整个艾滋病毒治疗级联。

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 R01 is to test a home-based ART intervention (ART initiation + 3-months ART care) plus motivational interviewing to increase ART initiation and 6-month viral suppression among men who test HIV-positive through Index HIVST in Malawi. The specific aims are: (1) test the effectiveness of home-based versus facility-based ART on ART initiation and 6-month viral suppression among male partners who test through Index HIVST; (2) Identify predictors of ART initiation and 6-month viral suppression; and (3) Determine the cost and cost-effectiveness of home-based ART versus facility-based among male partners using Index HIVST. The trial will provide urgent information on innovative HIV service delivery strategies for hard-to-reach-populations, such as men. Findings are expected to inform national policy and international recommendations around combined differentiated models that reach across the HIV treatment cascade.