Self-Test Strategies and Linkage Incentives to Improve ART and PrEP Uptake in Men

项目摘要 结束撒哈拉以南地区的艾滋病流行将需要男性进一步参与艾滋病毒检测、预防、 和治疗，这是一项具有挑战性的任务，因为在许多国家，近50%的艾滋病毒阳性男性不知道 她们的艾滋病毒状况和男性对艾滋病毒抗逆转录病毒疗法(ART)和暴露前预防的接受率较低 (准备)。这项研究的重点是肯尼亚维多利亚湖高度流动的男性--渔民 海岸线社区，那里艾滋病毒发病率极高。最近的两项创新-艾滋病毒自我 艾滋病毒检测(HIVST)和基于社交网络的干预--有望克服艾滋病毒检测的障碍 以及与艾滋病毒阳性和艾滋病毒阴性男子服务的联系。这项研究试图确定艾滋病毒是否 地位中立、以社交网络为基础的方法，加上低成本的激励措施，可以促进艾滋病毒检测， 将护理和预防联系起来，改善男性的健康状况。它将追求三个目标： 目标1：确定是否向以网络为中心的男性提供艾滋病毒自我检测，以便分发给其他男性 在她们亲密的社交网络中，增加了男性对艾滋病毒检测的接受。我们将开展社交网络 绘制肯尼亚锡亚县研究社区的地图，以确定男性独特的亲密社会网络。 然后，我们将把这些社交网络随机分成干预组和对照组。以网络为中心，高度 每个网络中有联系的男性将被招募为“推动者”，并接受HIVST培训。中的推动者 然后，被分配到干预行动的网络将接受自我测试，分发给他们网络中的男性。 分配给控制的网络中的推动者将在附近分发免费自我测试的代金券 健康诊所。我们假设，在接受干预的网络中，男性的艾滋病毒检测水平更高。 目标2：确定以网络为中心的推动者和小型激励是否可以增加ART和PrEP 在男性中的吸收。我们将测试以网络为中心的推动者是否可以加强与ART和PrEP的联系 在自我测试之后，从而解决了HIVST的一个关键限制。AIM 1干预组中的启动者 将被要求向他们网络中的男性分发ART或PrEP的信息和交通券。我们的 基本假设是，干预将导致与ART或PrEP(验证性)更高的关联率 检测和ART转诊为阳性，PrEP筛查为阴性)。我们还假设更高的艺术 并在3个月内在分配给干预组的社交网络中的男性中采用PrEP。 目的3：测试干预措施对ART或PrEP保留和依从性的影响。我们将测量6- 和12个月的VL和替诺福韦水平，使用最近开发的低成本、护理点PrEP依从性 尿液免疫分析。在所有目标中，我们将使用定性和混合方法来确定路径 干预行动，并了解社交网络和激励措施如何影响测试、ART和PrEP 摄取和保留。这项研究承诺对科学和公共健康产生高度影响，通过测试新的 改进预防和护理的方法在高优先环境中的高危流动男子中发生级联。

Project Summary Ending the AIDS epidemic in sub-Saharan will require further engagement of men in HIV testing, prevention, and treatment, a challenging task given that nearly 50% of HIV-positive men in many countries are unaware of their HIV status and men have lower uptake of HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). This study focuses on a highly mobile population of men – fishermen – in Kenya’s Lake Victoria shoreline communities, where HIV incidence rates are extremely high. Two recent innovations – HIV self- testing (HIVST) and social network-based interventions – hold promise for overcoming barriers to HIV testing and linkage to services for both HIV-positive and HIV-negative men. This study seeks to determine if an HIV status-neutral, social network-based approach, along with low-cost incentives, can promote HIV testing, linkage to care and prevention, and better health outcomes in men. It will pursue three aims: Aim 1: Determine whether providing HIV self-tests to network-central men for distribution to other men in their close social networks increases men’s HIV testing uptake. We will conduct social network mapping in study communities in Siaya Country, Kenya to identify distinct close social networks of men. We will then randomize these social networks to intervention and control groups. Network-central, highly- connected men in each network will be recruited as “promoters”, and receive HIVST training. Promoters in networks assigned to the intervention will then receive self-tests for distribution to men in their networks. Promoters in networks assigned to the control will instead distribute vouchers for free self-tests at nearby health clinics. We hypothesize higher HIV testing among men in networks that receive the intervention. Aim 2: Determine whether network-central promoters and small incentives can increase ART and PrEP uptake among men. We will test whether network-central promoters can enhance linkage to ART and PrEP after self-testing, thereby addressing a key limitation of HIVST. Promoters in the Aim 1 intervention group will be asked to distribute information and transport vouchers for ART or PrEP to men in their networks. Our primary hypothesis is that the intervention will result in higher rates of linkage to ART or PrEP (confirmatory testing and ART referral for positives, and PrEP screening for negatives). We also hypothesize higher ART and PrEP uptake within 3 months among men in social networks assigned to the intervention group. Aim 3: Test the impact of interventions on ART or PrEP retention and adherence. We will measure 6- and 12-month VL and tenofovir levels, using a recently-developed low-cost, point-of-care PrEP adherence urine immunoassay. Across all aims, we will use qualitative and mixed methods to identify the pathways of intervention action, and understand how social networks and incentives affect testing and ART and PrEP uptake and retention. This study promises high scientific and public health impact, by testing new approaches to improve the prevention and care cascades in high-risk, mobile men in high priority settings.