Reaching the last 20%: a targeted HIV self-test secondary distribution intervention to engage high-risk men in Kenya

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• 批准号: 10480476
• 负责人: Sue Napierala
• 金额: $ 66.89万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-06 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10480476
• 关键词: AIDS prevention; Address; Africa South of the Sahara; Caring; Clinic; Cluster randomized trial; Computerized Medical Record; Cost Effectiveness Analysis; Counseling; Couples; Data; Diagnosis; Diagnostic Reagent Kits; Effectiveness of Interventions; Enrollment; Epidemic; Face; Female; Geography; Goals; HIV; HIV Infections; Health; High Risk Woman; Hot Spot; Hour; Human immunodeficiency virus test; Individual; Intervention; Interview; Kenya; Liquid substance; Location; Measures; Modeling; Oral; Pathway interactions; Pattern; Persons; Pilot Projects; Population; Population Sizes; Positioning Attribute; Prevalence; Prevention; Qualitative Research; Questionnaires; Randomized; Reporting; Research; Research Personnel; Services; Sexual Partners; Testing; Woman; base; contextual factors; cost; cost effective; cost effectiveness; effectiveness evaluation; experience; follow-up; high risk; high risk men; high risk population; incremental cost-effectiveness; indexing; innovation; male; men; patient population; pilot test; pre-exposure prophylaxis; primary outcome; process evaluation; programs; randomized trial; recruit; secondary outcome; self testing; service delivery; sex; standard of care; testing services; tool; transmission process; trial design; uptake

PROJECT SUMMARY Limited use of HIV services by those at highest risk is one of the primary reasons for continued HIV transmission in sub-Saharan Africa. Identifying and engaging these individuals—particularly the 20% of people living with HIV who are unaware of their status—is a major challenge that is not being met by existing service delivery approaches. Men who purchase sex (MPS) are of particularly high priority because they are twice as likely to be HIV-infected as other men and are inherently challenging to identify and reach with HIV services. The proposed project will take place in the region of Kenya with the highest HIV prevalence and seeks to promote engagement in HIV testing, prevention, and care by MPS. Preliminary data demonstrate that “secondary distribution” of HIV self-tests by women who sell sex (WSS) to their sexual partners is acceptable, feasible, and safe and leads to high male partner testing. However, the use of post–self-test services has seldom been promoted or measured in a secondary distribution model. Our interdisciplinary and experienced team of Investigators will address this key gap. Led by an Early Stage Investigator, this project will use a pair-matched cluster-randomized trial design to test an innovative, well-targeted HIV self-test secondary distribution intervention to promote uptake of HIV services by MPS. Clusters served by Ministry of Health–supported HIV clinics will be randomized to receive the secondary distribution intervention or standard of care. In intervention clusters, we will recruit WSS from key population clinics and transactional sex “hot spots.” WSS will be provided with oral fluid–based HIV self-tests and encouraged to distribute them to their male transactional sex partners. Self-test kits will include salient information for men on clinic location and hours within their cluster, and pilot-tested messaging on the importance of early ART initiation, and the availability and benefits of PrEP. In Aim 1, we will evaluate programmatic data from HIV clinics in study clusters to objectively determine the intervention’s impact on uptake of confirmatory testing, ART initiation, and PrEP initiation by men. In Aim 2, we will conduct a process evaluation to characterize factors influencing intervention effectiveness. We will assess secondary distribution patterns and characterize the MPS population receiving self-tests through quantitative program data and a follow-up questionnaire among enrolled WSS. We will use qualitative data obtained through in-depth interviews with MPS to explore pathways and contextual factors influencing whether they accessed post-test services. In Aim 3, we will compute the incremental cost-effectiveness of our intervention to inform decisions about broader implementation. This project has the potential to break new ground on ways to engage high-risk and hard-to- reach populations in HIV services. If effective, our approach could be readily adapted to other settings and help advance global goals for HIV elimination.

项目摘要 高危人群对艾滋病毒服务的利用有限，是艾滋病毒持续传播的主要原因之一。 在撒哈拉以南非洲地区传播。识别和吸引这些人，特别是20%的人， 艾滋病毒感染者不知道自己的状况，这是现有服务无法应对的一个重大挑战 交付方法。购买性服务的男性（MPS）尤其受到高度重视，因为他们是男性的两倍。 他们可能像其他男性一样感染艾滋病毒，在确定和提供艾滋病毒服务方面具有固有的挑战性。 拟议的项目将在艾滋病毒流行率最高的肯尼亚地区实施，并力求 促进公共卫生部参与艾滋病毒检测、预防和护理。初步数据显示， 向其性伴侣提供性服务的妇女进行艾滋病毒自我检测的“二次分发”是可以接受的， 可行的，安全的，并导致高男性伴侣测试。然而，使用后自检服务， 很少在二级分销模式中推广或衡量。我们的跨学科和经验丰富 研究人员团队将解决这一关键差距。 在早期研究者的领导下，该项目将使用配对的随机分组试验设计， 测试一种创新的、目标明确的艾滋病毒自我检测二级分发干预措施，以促进艾滋病毒的吸收 服务MPS由卫生部支助的艾滋病毒诊所服务的群组将随机接受 二次分配干预或护理标准。在干预集群中，我们将从关键的 人口诊所和性交易“热点”。将为WSS提供基于口服液的HIV自检 并鼓励他们将其分发给男性交易性伴侣。自检工具包将包括 为男性提供关于诊所位置和所在群组内时间的信息， 早期ART启动的重要性，以及PrEP的可用性和益处。在目标1中，我们将评估 研究组中艾滋病毒诊所的方案数据，以客观地确定干预措施对 男性接受确证性检测、ART启动和PrEP启动。在目标2中，我们将开展一项进程， 评估以确定影响干预效果的因素。我们将评估二次分配 模式和特征的MPS人口接受自我测试，通过定量程序数据和 在入组的WSS中进行随访问卷调查。我们将使用通过深入访谈获得的定性数据 与MPS探讨影响他们是否获得测试后服务的途径和背景因素。在 目标3，我们将计算我们的干预措施的增量成本效益，为更广泛的决策提供信息。 实施.该项目有可能在参与高风险和难以实现的 向艾滋病毒服务的人群提供服务。如果有效，我们的方法可以很容易地适应其他环境， 推动实现消除艾滋病毒的全球目标。