ITEST: Innovative Tools to Expand Youth-Friendly HIV Self-Testing

ITEST：扩大青少年友好的艾滋病毒自我检测的创新工具

• 批准号: 10470245
• 负责人: Juliet Iwelunmor
• 金额: $ 128.52万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-09-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10470245
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Africa; Africa South of the Sahara; African; American; Anal Sex; Area; Behavioral; Benchmarking; Chlamydia; Clinical Trials Data Monitoring Committees; Communities; Country; Creativeness; Data; Decentralization; Development; Effectiveness; Ensure; Epidemic; Evaluation; Fright; Goals; Gonorrhea; Government; Guidelines; HIV; HIV Infections; HIV Seronegativity; Human immunodeficiency virus test; Incidence; Individual; Infection; Institutional Review Boards; Intervention; Learning; Link; Local Government; Mentorship; Modality; National Institute of Child Health and Human Development; Newly Diagnosed; Nigeria; Nigerian; Outcome; Patient Self-Report; Persons; Phase; Policies; Prevention strategy; Preventive; Preventive service; Privacy; Procedures; Process; Public Health; Randomized; Randomized Controlled Trials; Request for Applications; Research; Research Priority; Risk; Sampling; Services; Sexually Transmitted Diseases; Social Problems; Social support; Specimen; Syphilis Serodiagnosis; Testing; United States National Institutes of Health; Vagina; World Health Organization; Youth; age group; aged; apprenticeship; authority; base; community based participatory research; condoms; design; disparity reduction; effectiveness evaluation; experience; experimental study; high risk; implementation intervention; implementation strategy; improved; innovation; low and middle-income countries; multidisciplinary; pre-exposure prophylaxis; preference; prevent; prevention service; primary outcome; recruit; resilience; response; secondary outcome; self testing; service uptake; skills; social; social stigma; success; supportive environment; testing services; therapy development; tool; transmission process; trial readiness; uptake; willingness

ABSTRACT HIV incidence remains high among youth aged 14-24 in Sub-Saharan Africa, thus underscoring the importance of interventions to prevent HIV in this age group. Nigerian youth are at the epicenter of an expanding HIV crisis, with the second largest number of new youth HIV infections of any country. Yet fewer than one in five Nigerian youth have ever been HIV tested. Young people are often framed as the fraught victims of new HIV infections, instead of recognizing their resilience and power in advancing effective response to the epidemic. Conventional expert-driven, top-down interventions have largely failed. Innovative solutions that leverage the resourcefulness and resilience of youth are sorely needed. In this proposal, we will develop innovative youth-friendly HIV self-testing services based on open challenges and apprenticeships that are informed by a youth participatory action research framework. Open challenges solicit solutions from the community and then implement the best solutions, while apprenticeship builds local capacity for youth-led projects to increase the likelihood of success and ensure comprehensive evaluation. Three randomized controlled trials based on open challenges have led to improved rates of HIV testing and condom use among at-risk youth, but none of these approaches have been in Africa. These participatory approaches will be used to identify innovative HIV self-testing strategies that meet the specific needs of Nigerian youth. Each strategy will have a comprehensive plan for enhancing HIV prevention (including HIV pre- exposure prophylaxis and behavioral approaches) among at-risk youth. Two HIV self-testing strategies will be selected by judges as semi-finalists and evaluated in separate local government area pilots (UG3 phase). Once the project meets stringent requirements demonstrating trial readiness and pilot effectiveness, a single strategy will be evaluated in a pragmatic, cluster randomized controlled trial in 24 local government areas of Nigeria (UH3 phase). The intervention development process will build capacity for decentralized HIV self- testing, drawing on the strengths, creativity, and engagement of Nigerian youth. Leveraging our extensive experience organizing HIV research in Nigeria, we propose the following specific aims: (1) To use open challenges and apprenticeship to develop new HIV self-testing services; (2) To evaluate the effectiveness of two semi-finalist participatory interventions on HIV testing and other key prevention services among at-risk, HIV-negative youth (14-24years old); (3) To determine the effectiveness of a finalist participatory intervention on HIV testing and other key HIV prevention outcomes in 24 areas using a stepped wedge, pragmatic randomized controlled trial. The overarching goal is not to create a monolithic “one-size fits all” HIV self-testing strategy, but rather to demonstrate that open challenges can engage and inspire youth to develop innovative and effective HIV services. Our focus on open challenges and tailoring services to youth resonates with NICHD, NIH, and US government strategic priorities.

摘要 撒哈拉以南非洲14-24岁青年的艾滋病毒发病率仍然很高，因此突显出 在这个年龄段预防艾滋病毒的干预措施的重要性。尼日利亚青年正处于一场 艾滋病毒危机不断扩大，新感染艾滋病毒的青年人数在所有国家中排名第二。但数量更少 超过五分之一的尼日利亚青年曾接受过艾滋病毒检测。年轻人经常被框定为令人担忧的 新的艾滋病毒感染的受害者，而不是认识到他们在有效地推动 对疫情的反应。传统的专家驱动、自上而下的干预措施基本上失败了。创新型 迫切需要利用青年的足智多谋和韧性的解决方案。在这项提案中，我们将 根据开放式挑战和学徒制，开发创新的青年友好型艾滋病毒自我检测服务 由青年参与性行动研究框架提供信息。公开挑战向以下各方征集解决方案 社区，然后实施最好的解决方案，而学徒制建设地方能力，以青年为主导 项目，以增加成功的可能性，并确保全面评价。三随机化 基于公开挑战的对照试验提高了艾滋病毒检测和避孕套使用率 高危青年，但这些方法都没有出现在非洲。这些参与性的方法将被使用 确定创新的艾滋病毒自我检测战略，以满足尼日利亚青年的具体需求。每种策略 将有一个全面的计划来加强艾滋病毒预防(包括艾滋病毒暴露前预防和 行为方法)在高危青年中。评委将选择两种艾滋病毒自我检测策略作为 半决赛并在单独的地方政府地区试点中进行评估(UG3阶段)。一旦项目相遇 证明试验准备情况和试验有效性的严格要求，单一的战略将是 在尼日利亚24个地方政府地区(UH3)进行了务实的整群随机对照试验 阶段)。干预发展进程将建设分散的艾滋病毒自我检测、抽签的能力 尼日利亚青年的优势、创造力和参与度。利用我们丰富的经验 在尼日利亚组织艾滋病毒研究，我们提出了以下具体目标：(1)利用开放的挑战和 学徒开发新的艾滋病毒自我检测服务；(2)评估两个半决赛的效果 在艾滋病毒阴性的高危人群中开展艾滋病毒检测和其他关键预防服务的参与性干预 青年(14-24岁)；(3)确定最终入围的参与性艾滋病毒干预措施的有效性 在24个地区进行检测和其他关键的艾滋病毒预防成果，采用梯级楔形，务实随机 对照试验。首要目标不是创造一个单一的“一刀切”的艾滋病毒自我检测战略， 而是为了证明开放的挑战可以吸引和激励年轻人发展创新和 有效的艾滋病毒服务。我们对开放挑战和为青年量身定做的服务的关注引起了NICHD的共鸣， 以及美国政府的战略重点。

项目成果

Understanding factors that promote uptake of HIV self-testing among young people in Nigeria: Framing youth narratives using the PEN-3 cultural model.

• DOI: 10.1371/journal.pone.0268945
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7

Sustaining HIV Research in Resource-Limited Settings Using PLAN (People, Learning, Adapting, Nurturing): Evidence from the 4 Youth by Youth Project in Nigeria.

• DOI: 10.1007/s11904-023-00652-2
• 发表时间: 2023-04
• 期刊: Current HIV/AIDS reports
• 影响因子: 4.6

Designing HIV Testing and Self-Testing Services for Young People in Nigeria: A Discrete Choice Experiment.

• DOI: 10.1007/s40271-021-00522-2
• 发表时间: 2021-11
• 期刊: The patient
• 作者: Ong JJ;Nwaozuru U;Obiezu-Umeh C;Airhihenbuwa C;Xian H;Terris-Prestholt F;Gbajabiamila T;Musa AZ;Oladele D;Idigbe I;David A;Okwuzu J;Bamidele T;Iwelunmor J;Tucker JD;Ezechi O
• 通讯作者: Ezechi O

Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review.

在撒哈拉以南非洲实施基于社区的艾滋病毒检测干预措施的成本：系统评价。

• DOI: 10.1186/s43058-021-00177-y
• 发表时间: 2021-07-05
• 期刊: Implementation science communications
• 作者: Uzoaru F;Nwaozuru U;Ong JJ;Obi F;Obiezu-Umeh C;Tucker JD;Shato T;Mason SL;Carter V;Manu S;BeLue R;Ezechi O;Iwelunmor J
• 通讯作者: Iwelunmor J