Integrating U=U into HIV counseling in South Africa (INTUIT-SA)

项目摘要 通过抗逆转录病毒疗法(ART)几乎消除了艾滋病毒的传播，为世界提供了一个明确的 通过在诊断时大规模提供抗逆转录病毒疗法，即检测和治疗，来结束艾滋病毒流行的途径。尽管 抗逆转录病毒疗法的预防益处非常大，但我们发现治疗即预防(TasP)的知识非常有限。 在我们最近在南非进行的两项基于人口的调查中(Bor K01)。事实上，目前的公共卫生 南非的信息传递和临床艾滋病毒咨询并不强调抗逆转录病毒疗法的预防益处。 2016年，发起了U=U运动，以传播艾滋病毒携带者 如果他们的病毒载量检测不到，就不能传播病毒。U=U已得到美国国立卫生研究院和 近100个国家和地区的组织。坊间证据表明，提供有关U=U的信息可能会减少 耻辱和改善PLWH的幸福感，并可能通过呼吁增加ART的摄取率和依从性 避免传播给其他人的愿望。尽管关于U=U的科学很清楚，但目前有 关于(A)如何最好地将有关U=U的信息整合到艾滋病毒咨询服务中的关键证据差距， 以及(B)U=U消息对PLWH的幸福感和求医行为有何影响。 我们提出了一项形成性研究研究(R34)来开发基于APP的教育视频干预 将提供关于U=U的信息，这些信息适合当地并可纳入常规艾滋病毒咨询。 我们将在接受艾滋病毒检测后和依从性咨询的患者的临床试验中试点这种干预措施 服务，以确定可行性和可接受性，对U=U知识和态度的影响，对 耻辱和心理健康，以及ART摄取、坚持和病毒监测的初步证据 和镇压。这项研究建立在波士顿大学和美国卫生署之间的长期合作基础上 南非威特沃特斯兰德大学经济学和流行病学研究室(HE2RO)。 这项研究具有很高的创新性，因为我们采用了一种新的方法-在 抗逆转录病毒疗法的预防益处--改善南非妇女健康中心的福祉，并促使南非尽早采用抗逆转录病毒疗法。 研究结果将成为R01提案的依据，该提案旨在评估这种干预对 整群随机疗效试验。这项研究将对公共卫生产生重大影响，因为研究结果 有可能在这个拥有世界上最大艾滋病毒流行的国家制定艾滋病毒咨询指导方针和做法。 我们假设，将治疗作为预防出售的好处可以大大改善福祉。 提高可持续健康水平，增加对抗逆转录病毒治疗的需求，使各国能够最大限度地发挥检测和治疗的影响。

Project Summary The near-elimination of HIV transmission with antiretroviral therapy (ART) has provided the world with a clear path to end the HIV epidemic through the mass provision of ART at diagnosis, i.e. test-and-treat. Despite the very large prevention benefits of ART, we found very limited knowledge of treatment-as-prevention (TasP) in two population-based surveys we recently conducted in South Africa (Bor K01). Indeed, current public health messaging and clinical HIV counseling in South Africa do not emphasize the prevention benefits of ART. In 2016, U=U Campaign was launched to disseminate the scientific evidence that people with HIV cannot transmit the virus if their viral load is undetectable. U=U has been endorsed by NIH and by organizations in nearly 100 countries. Anecdotal evidence suggests providing information on U=U may reduce stigma and improve wellbeing of PLWH, and may lead to increased ART uptake and adherence by appealing to the desire of PLWH to avoid transmission to others. Although the science on U=U is clear, there is currently a critical evidence gap on (a) how best to integrate information on U=U into HIV counseling services, and (b) what impact U=U messaging has on wellbeing of PLWH and on treatment-seeking behaviors. We propose a formative research study (R34) to develop an app-based educational video intervention that will provide information on U=U that is locally-appropriate and can be integrated into routine HIV counselling. We will pilot the intervention in a clinical trial of patients receiving HIV post-test and adherence counseling services, in order to determine feasibility and acceptability, impact on U=U knowledge and attitudes, impact on stigma and psychological wellbeing, and preliminary evidence for ART uptake, adherence, and viral monitoring and suppression. The study builds on a longstanding collaboration between Boston University and the Health Economics and Epidemiology Research Office (HE2RO) at the University of Witwatersrand in South Africa. This study is highly innovative because we take a novel approach – disseminating information on the prevention benefits of ART – to improve wellbeing of PLWH and motivate early uptake of ART in South Africa. Study results will inform an R01 proposal to evaluate the impact of this intervention on viral suppression in a cluster-randomized efficacy trial. The research will have significant public health impact as the findings have potential to shape HIV counseling guidelines and practice in the country with the world’s largest HIV epidemic. We hypothesize that selling treatment-as-prevention on its merits could substantially improve wellbeing of PLWH and increase demand for ART, enabling countries to maximize the impact of test-and-treat.