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

将 U=U 纳入南非的艾滋病毒咨询 (INTUIT-SA)

• 批准号: 10227801
• 负责人: Jacob Bor
• 金额: $ 21.85万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227801
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Africa; Altruism; Appointment; Attitude; Behavior; Boston; Cellular Phone; Child; Clinic; Clinical; Clinical Trials; Collaborations; Consensus; Counseling; Country; Couples; Data; Diagnosis; Disclosure; Education; Effectiveness; Epidemic; Europe; Exercise; Exposure to; Focus Groups; Generations; Guidelines; HIV; HIV Infections; HIV therapy; Intervention; Interview; Knowledge; Lead; Mental Health; Monitor; Motivation; Participant; Patients; Personal Satisfaction; Persons; Policies; Prevention; Prevention strategy; Professional counselor; Public Health; Public Sector; Randomized; Records; Research; Risk; Risk-Taking; Rural; Science; Secondary Prevention; Self Efficacy; Series; Services; Shapes; Societies; South Africa; Standardization; Surveys; Tablets; Testing; Text Messaging; Training; United States National Institutes of Health; Universities; Unsafe Sex; Vertical Disease Transmission; Viral; Viral Load result; Virus; Well in self; Work; acceptability and feasibility; antiretroviral therapy; arm; base; care seeking; design; efficacy trial; epidemiology study; experience; health economics; improved; infection risk; innovation; intervention mapping; literacy; novel strategies; pilot trial; population based; prevent; psychologic; recruit; research study; social stigma; therapy adherence; transmission process; treatment arm; treatment as prevention; university student; uptake; young adult

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.

项目概要 抗逆转录病毒疗法（ART）几乎消除了艾滋病毒传播，这为世界提供了明确的解决方案 通过在诊断时大规模提供抗逆转录病毒治疗（即检测和治疗）来结束艾滋病毒流行的途径。尽管 ART 的预防益处非常大，但我们发现对治疗即预防 (TasP) 的了解非常有限 我们最近在南非进行了两项基于人口的调查（Bor K01）。事实上，当前的公共卫生 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治疗的预防益处。 2016 年，发起了“U=U 运动”，旨在传播艾滋病毒感染者的科学证据 如果病毒载量检测不到，则无法传播病毒。 U=U 已得到 NIH 和 近100个国家的组织。轶事证据表明，提供有关 U=U 的信息可能会减少 耻辱并改善感染者的福祉，并可能通过吸引来增加抗逆转录病毒治疗的采用和依从性 以满足感染者避免传染给他人的愿望。尽管 U=U 的科学原理很明确，但目前还存在 在 (a) 如何最好地将 U=U 信息纳入艾滋病毒咨询服务方面存在关键证据差距， (b) U=U 信息对感染者的福祉和寻求治疗行为有何影响。 我们提出一项形成性研究（R34），以开发基于应用程序的教育视频干预， 将提供适合当地且可纳入常规艾滋病毒咨询的有关 ​​U=U 的信息。 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行干预措施 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 接受、依从性和病毒监测的初步证据 和镇压。该研究建立在波士顿大学与卫生部门之间的长期合作基础上 南非威特沃特斯兰德大学经济和流行病学研究办公室 (HE2RO)。 这项研究具有高度创新性，因为我们采用了一种新颖的方法——传播关于 抗逆转录病毒疗法的预防益处——改善艾滋病病毒感染者的福祉并激励南非尽早接受抗逆转录病毒疗法。 研究结果将为 R01 提案提供信息，以评估这种干预措施对病毒抑制的影响 整群随机疗效试验。该研究将对公共卫生产生重大影响，因为研究结果表明 在世界上艾滋病毒流行最严重的国家制定艾滋病毒咨询指南和实践的潜力。 我们假设，推销以治疗为预防的优点可以大大改善福祉 艾滋病毒感染者和艾滋病患者的数量并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。