RCT to reduce HIV acquisition and viral load among migrants, Rakai, Uganda

项目概要（摘要） 乌干达的Rakai健康科学方案提议建立一个执行科学界， 随机对照试验（CRCT）的一种新的干预措施，以新移民的个人（“欢迎在- 未来的邻居”[WIN]），以优化其与艾滋病毒预防综合服务的快速联系。RHSP 数据显示，在移民后的头36个月内，与居民相比，艾滋病毒阴性的移民 感染艾滋病毒的风险增加，艾滋病毒阳性的移民未充分利用抗逆转录病毒疗法 增加了进一步传播的风险。基于理论的WIN干预包括社区 提高认识，以社区为基础的WIN童子军（WINs），以及加强的，有区别的诊所服务， 移民。WINs将进行积极的社区监测，以迅速识别和欢迎移民， 向他们提供有关热电联产可用性和居民高使用率的信息（以“正常化”吸收）， 利用动机访谈方法鼓励采用卫生防护中心，将移民转介到免费服务， 提供医疗券，使他们能够获得优先诊所服务，并跟踪移民， 进一步鼓励参与卫生防护中心。具体目的：目的1：随机分配40个单独匹配的 与WIN干预或对照组的比例为1：1。每组中15-49岁的移民将 接受基线调查和2次随访调查，间隔约18个月。主要终点是艾滋病毒感染率， 最初HIV阴性的入境者（每组n ~ 3，800 py），HIV阳性的病毒载量抑制（每组n ~740）。 还将比较CHP覆盖率和性行为（次要结果）。目标2a：使用 混合方法（深度访谈，过程和调查数据）和RE-AIM（范围，有效性， 采用、实施、维护），以（i）必要时指导临时干预调整;（ii）解释 试验结果;及（iii）将研究成果转化为未来的行动。目标2b：进行成本研究， 关于负担能力和可持续性的信息。创新和影响：这种新颖的干预将迅速 让移民中的弱势优先人群参与进来，以优化卫生保健方案和艾滋病毒在乌干达农村地区的影响。

PROJECT SUMMARY (ABSTRACT) The Rakai Health Sciences Program (RHSP), Uganda, proposes an implementation science community- randomized controlled trial (CRCT) of a novel intervention to newly in-migrated individuals (“Welcome In- coming Neighbor” [WIN]), to optimize their rapid linkage to combination HIV prevention (CHP) services. RHSP data show that within the first 36 months after in-migration, compared to residents, HIV-negative in-migrants are at increased risk of HIV acquisition and HIV+ in-migrants underutilize antiretroviral therapy (ART) increasing the risk of onward transmission. The theory-based WIN intervention includes community sensitization, community-based WIN scouts (WINs), and enhanced, differentiated clinic services for in- migrants. WINs will conduct active community surveillance to rapidly identify and welcome in-migrants, provide them with information about the availability of CHP and high rates of use by residents (to “normalize” uptake), utilize a motivational interviewing approach to encourage CHP adoption, refer in-migrants to free services, provide vouchers enabling them to receive priority clinic services, and follow-up in-migrants to assess and further encourage engagement in CHP. Specific Aims: Aim 1: To randomize 40 individually matched communities in a 1:1 ratio to the WIN intervention or control arm. In-migrants aged 15-49 in each arm will undergo a baseline and 2 follow-up surveys at ~18-month intervals. Primary end points are HIV incidence in initially HIV-negative in-migrants (n ~3,800 py per arm), and viral load suppression in HIV+ (n ~740 per arm). CHP coverage rates and sexual behaviors will also be compared (secondary outcomes). Aim 2a: To use a mixed methods approach (in-depth interviews, process & survey data) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to (i) guide interim intervention adaptation as necessary; (ii) interpret trial results; and, (iii) translate the research into future action. Aim 2b: To conduct cost studies to provide information on affordability and sustainability. Innovation and Impact: This novel intervention will rapidly engage a vulnerable priority population of in-migrants, to optimize CHP and HIV impact in rural Uganda.