Engaging men through HIV self-test and differentiated care models to increase ART initiation and viral suppression 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R01的主要目标是测试基于家庭的ART干预(ART启动+3个月ART 护理)加上激励性采访，以增加ART的启动和对以下男性的6个月病毒抑制 在马拉维通过HIVST指数检测艾滋病毒阳性。具体目标是：(1)检验居家服务的有效性 与基于设施的ART启动和6个月病毒抑制在男性伴侣中的对比 HIVST指数；(2)确定ART启动和6个月病毒抑制的预测因素；以及(3)确定成本 在使用Index HIVST的男性伴侣中，基于家庭的ART与基于设施的ART的成本效益。这个 试验将提供关于为难以接触到的人群提供创新的艾滋病毒服务战略的紧急信息， 比如男人。预计调查结果将为国家政策和国际建议提供参考 跨艾滋病毒治疗级联的组合差异化模型。

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.