Improving HIV testing, linkage, and retention in care for men through U=U messaging

通过 U=U 信息传递改善男性的 HIV 检测、联系和护理保留

• 批准号: 10483486
• 负责人: Alison Meredith Buttenheim
• 金额: $ 59.2万
• 依托单位: DESMOND TUTU HIV FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10483486
• 关键词: AIDS prevention; Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Africa South of the Sahara; Anxiety; Area; Behavioral Sciences; Caring; Clinic; Collaborations; Communicable Diseases; Communities; Continuity of Patient Care; Counseling; Country; Coupled; Data; Effectiveness; Effectiveness of Interventions; Epidemic; Epidemiology; Evaluation; Fright; Gender; Goals; Government; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Benefit; High Prevalence; Human immunodeficiency virus test; Incidence; Income; Intervention; Knowledge; Learning; Methods; Outcome; Participant; Penetration; Persons; Prevalence; Process; Province; Randomized; Research; Resources; Safe Sex; Sexual Partners; Shapes; Site; South Africa; Testing; Unsafe Sex; Viral; Viral Load result; Woman; Work; antiretroviral therapy; base; behavioral economics; cis-male; clinical practice; contextual factors; effectiveness evaluation; effectiveness-implementation RCT; experience; future implementation; human centered design; implementation barriers; implementation efforts; implementation facilitation; improved; innovation; insight; male health; men; mortality risk; peer; primary outcome; prototype; randomized trial; secondary outcome; service delivery; service uptake; sexual HIV transmission; standard of care; successful intervention; testing services; testing uptake; theories; therapy adherence; tool; treatment adherence; treatment as prevention; uptake; yeast two hybrid system

PROJECT ABSTRACT Increasing the coverage of HIV testing and treatment among people living with HIV (PLHIV) is essential for ending the global AIDS epidemic. Unfortunately, compared to women, men living with HIV (MLHIV) are less likely to know their HIV status, start anti-retroviral treatment, or achieve viral suppression. Given that new HIV infections among women are driven, in part, by men’s testing and treatment gaps, reducing the gender gap in testing uptake, treatment initiation and achievement of viral suppression by men must be prioritized in order to accelerate the decline in HIV incidence among women, improve men’s HIV-related health outcomes and achieve the UNAIDS 95-95-95 goals by 2030. In this study, we evaluate the effectiveness of Undetectable Equals Untransmittable or “U=U” messaging for closing the gender gap in the HIV cascade. The U=U message communicates the compelling idea that PLHIV who take ART and have an undetectable viral load (<200 copies/mL) cannot sexually transmit HIV. Particularly for men, the U=U message has the potential to accelerate progress towards the 95-95-95 targets by: 1) reducing anxiety associated with HIV testing (1st 95); 2) encouraging people who test HIV-positive to initiate ART (2nd 95); and 3) reducing fear of transmitting HIV to sexual partners by promoting treatment adherence to achieve viral suppression (3rd 95). While there is a growing knowledge of Treatment as Prevention (TasP)/U=U among PLWH in Western countries, the reach and penetration of the U=U message in sub-Saharan Africa has been limited and few studies have tested the impacted of accessible U=U messages on ART uptake and adherence in sub-Saharan Africa. Building on our prior work on U=U messaging informed by behavioral economics and human-centered design, we propose to conduct two hybrid type 1 effectiveness-implementation randomized controlled trials to evaluate the impact of U=U messages on men’s uptake of community-based HIV testing and treatment initiation (Aim 1), and achievement of viral suppression (Aim 2). We will also conduct a multi-method evaluation to inform future implementation of U=U messaging interventions. To improve the generalizability of our findings, we will conduct our study in two provinces in South Africa (Western and Eastern Cape). If effective, our intervention can shape global HIV testing and treatment counselling guidelines and practices. Our expert, multi-institutional collaborations will allow us to apply previous research findings, leverage unique implementation platforms and resources, and rapidly disseminate our findings.

项目摘要 增加艾滋病毒感染者（PLHIV）中艾滋病毒检测和治疗的覆盖率对于以下方面至关重要： 结束全球艾滋病流行。不幸的是，与女性相比，男性艾滋病毒感染者（MLHIV）较少 他们可能知道自己的艾滋病毒状况，开始抗逆转录病毒治疗，或实现病毒抑制。鉴于新的艾滋病毒 女性感染的部分原因是男性的检测和治疗差距， 必须优先考虑男性接受检测、开始治疗和实现病毒抑制， 加快妇女艾滋病毒发病率的下降，改善男子与艾滋病毒有关的健康结果， 联合国艾滋病规划署到2030年的95-95-95目标。在这项研究中，我们评估的有效性不可检测的平等 无法传递或“U=U”的信息，以缩小艾滋病毒级联中的性别差距。U=U消息 传达了一个令人信服的想法，即接受抗逆转录病毒治疗且病毒载量检测不到（<200 拷贝/毫升）不能通过性传播艾滋病毒。特别是对男人来说，U=U的信息有可能加速 通过以下方式实现95-95-95目标：1）减少与艾滋病毒检测相关的焦虑（第一个95年）; 2）鼓励 艾滋病毒检测呈阳性的人开始抗逆转录病毒治疗（第2个95）;以及3）减少对将艾滋病毒传染给性伴侣的恐惧 通过促进治疗依从性来实现病毒抑制（3rd 95）。虽然越来越多的人知道 在西方国家的艾滋病毒/艾滋病感染者中，U= U的覆盖面和渗透率 撒哈拉以南非洲的信息有限，很少有研究测试可访问U=U的影响 关于撒哈拉以南非洲抗逆转录病毒疗法的接受和坚持的信息。基于我们之前在U=U消息传递方面的工作 根据行为经济学和以人为本的设计，我们建议进行两种混合型1 有效性-实施随机对照试验，以评估U=U消息对男性的影响 接受基于社区的艾滋病毒检测和开始治疗（目标1），并实现病毒抑制 (Aim 2）。我们还将进行多方法评估，为U=U消息传递的未来实施提供信息 干预措施。为了提高研究结果的普遍性，我们将在南方两个省进行研究， 非洲（西开普省和东开普省）。如果有效，我们的干预措施可以影响全球艾滋病毒检测和治疗 咨询指导方针和做法。我们的专家，多机构合作将使我们能够应用以前的 研究成果，利用独特的实施平台和资源，并迅速传播我们的 调查结果。