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)涉及对以下客户的公共卫生合同跟踪 艾滋病毒或其他性传播感染，以便秘密通知接触者其 并将其与检测和治疗服务联系起来。通过几个随机对照 试验(RCT)，APS已被证明是增加艾滋病毒检测的一种经济有效的策略 和案件识别。一些在中低收入人群中大规模实施的APS计划 各国未能取得最佳结果，因为APS参与者通常只列出 他们目前的性伴侣或没有通知他们的伴侣。寻找创新的方法来增加 吸引的合作伙伴数量和完成艾滋病毒检测的数量是规模化成功的关键- 向上。在乌克兰，艾滋病毒在成年人中的流行率估计为1%，在有性行为的男性中为7.5% 男性(MSM)和注射吸毒者(PWID)中的22.6%。有一个实质性的 艾滋病毒携带者中未确诊的比例，总体估计为25%，男男性接触者中为41%，以及 在PWID中占42%。乌克兰在2019-21年间扩大了40个公共部门卫生设施的APS； 然而，联系人指数(每个索引客户指定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，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访(CASI) 步骤：1)最初的接触启发式面试，旨在减少社会期望偏见 与报告多个性伴侣、同性性伴侣或共用针头有关 合作伙伴；以及2)重复的客户跟踪调查和卫生工作者敬业度提示 通过合作伙伴通知和测试促进沟通和案例管理 进程。从卫生工作者那里开展形成性研究 和客户角度设计CASI-Plus mHealth干预措施 评估CASI-Plus的采用情况及其对接触启发的影响 评估适当性和可行性 CASI-Plus干预及其对APS服务总体可接受性的影响。 测试。 研究的具体目标是：1)(R21) 和2)(R21)在试行级 RCT，；3)(R33)测试 关于扩大的随机对照试验中的艾滋病毒检测指数；和4)(R33) 这项研究 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。这一伙伴关系提供了巨大的潜力来整合 将移动健康解决方案引入国家健康信息系统，并将研究成果转化为 政策和实践，应具有较强的可接受性、适当性、可行性和有效性。

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.