CASI-Plus: A mHealth Tool for Client Engagement to Improve Ukraine's Assisted Partner Services (APS) Program Workflow and HIV Testing Outcomes

项目摘要 协助合作伙伴通知服务（APS）涉及对客户的公共卫生合同跟踪， 艾滋病毒或其他性传播感染，以便秘密通知其联系人， 并将其与检测和治疗服务联系起来。通过几个随机对照 在随机对照试验（RCT）中，APS已被证明是增加HIV检测的成本效益策略 和案件识别。在低收入和中等收入国家大规模实施的一些APS方案 由于APS参与者通常只提到 他们目前的性伴侣或没有通知他们的伴侣。寻找创新方法， 获得的合作伙伴数量和完成艾滋病毒检测的数量对规模成功至关重要- 起来在乌克兰，成人艾滋病毒感染率估计为1%，有性行为的男性为7.5%， 在男性（男男性行为者）和注射毒品者（PWID）中，这一比例为22.6%。存在相当大 未确诊的艾滋病毒感染者比例，估计总体为25%，男男性行为者为41%， 42%在PWID中。乌克兰在2019- 2021年在40个公共部门卫生设施中扩大了APS; 然而，联系人指数（每个索引客户端命名的合作伙伴联系人数量）仅为1.14， 性伴侣和共用针头的伴侣，以及23.3%的身份不明的伴侣没有完成 CASI-Plus mHealth工具利用计算机辅助自我访谈（CASI）， 步骤：1）最初的接触诱导访谈，旨在减少社会期望偏差 与报告多个性伴侣、同性性伴侣或共用针头有关 合作伙伴;和2）重复的客户跟踪调查和卫生工作者参与提示， 通过合作伙伴通知和测试促进沟通和案例管理 过程从卫生工作者那里进行形成性研究 和客户的观点来设计CASI-Plus移动健康干预措施 评估CASI-Plus的采用及其对接触引出的影响 评估适当性和可行性 CASI-Plus干预及其对APS服务整体可接受性的影响。 试验. 本研究的具体目标是：1）（R21） （2）（R21）在先导级 RCT，; 3）（R33）试验 在一项扩展RCT中对艾滋病毒检测指数进行评估;以及4）（R33） 研究 团队包括APS计划、数字健康开发、可用性评估和 来自华盛顿大学和乌克兰的混合方法卫生服务研究 卫生部公共卫生中心。这种伙伴关系提供了巨大的潜力， 将移动医疗解决方案纳入国家卫生信息系统，并将研究结果转化为 政策和做法的可接受性、适当性、可行性和有效性应该很强。

Project Abstract Assisted partner notification services (APS) involves public health contract tracing for clients with HIV or other sexually transmitted infections, in order to confidentially notify contacts of their exposure and link them to testing and treatment services. Through several randomized controlled trials (RCTs), APS has been demonstrated as a cost-effective strategy for increasing HIV testing and case identification. Some APS programs implemented at scale in low- and middle-income countries have fallen short of optimal outcomes, because APS participants typically only name their current sex partner or fail to notify their partners. Finding innovative ways to increase the number of partners elicited and the number completing HIV testing is critical to success in scale- up. In Ukraine, HIV prevalence is estimated at 1% among adults, 7.5% among men who have sex with men (MSM), and 22.6% among persons who inject drugs (PWID). There is a substantial undiagnosed fraction of people living with HIV, estimated at 25% overall, 41% among MSM, and 42% among PWID. Ukraine scaled up APS in 40 public-sector health facilities in 2019-21; however, the contact index (number of partner contacts named per index client) was only 1.14 for sexual and needle-sharing partners, and 23.3% of partners with unknown status did not complete The CASI-Plus mHealth tool leverages computer-assisted self-interviews (CASI) in 2 steps: 1) an initial contact elicitation interview designed to reduce social desirability bias associated with reporting multiple sexual partners, same-sex sexual partners, or needle-sharing partners; and 2) repeated client follow-up surveys and health worker engagement prompts to facilitate communication and case management through the partner notification and testing process. conduct formative research from health worker and client perspectives to design the CASI-Plus mHealth intervention assess adoption of CASI-Plus and its impact on contact elicitation CASI-Plus assess appropriateness and feasibility of the CASI-Plus intervention and its impact on overall acceptability of APS services. testing. The study’s specific aims are to: 1) (R21) ; and 2) (R21) in a pilot-level RCT, ; 3) (R33) test on the HIV testing index in an expanded RCT; and 4) (R33) The research team includes experts in APS programs, digital health development, usability assessment, and mixed methods health services research from the University of Washington and the Ukraine Ministry of Health’s Public Health Center. This partnership offers great potential to integrate the mHealth solution into the national health information system and translate research findings into policy and practice, should acceptability, appropriateness, feasibility and effectiveness be strong.