Confidential social network referrals for HIV testing (CONSORT)

联合国艾滋病规划署为2030年设定了雄心勃勃的95-95-95目标：诊断95%的艾滋病毒感染者（PWH）， 对95%的确诊患者开始抗逆转录病毒治疗，并对95%的患者实现病毒抑制。 治疗。在坦桑尼亚这个艾滋病紧急救援计划战略国家，成人艾滋病毒感染率为4.8%，只有83%的工作人员是 意识到他们的地位。超过20万名未确诊的PWH需要进行检测，以达到“前95名”。 随着传统HIV检测方法的成本效益下降，我们建议评估一种新的 移动的健康（mHealth）技术的应用，该技术利用移动的电话的普及和 社交网络，以提高艾滋病毒检测率，特别是在高危人群中。具体来说，我们将 评估自动化、保密、基于SMS的HIV检测的可接受性、有效性和成本效益 转介，作为一种手段，'轻推'个人测试。我们假设一个自动的，保密的推荐 在坦桑尼亚的基利曼哈罗地区开发和部署的一个系统将被两个索引客户接受 这将有助于提高艾滋病毒检测率。利用现有 与研究地区所有25个艾滋病毒咨询和检测（HCT）提供者的关系，包括8个艾滋病毒护理和 治疗中心（CTC），并使用开源、低代码和高度通用的基于移动的电话的 为了建立预约提醒和奖励制度，这项研究将实现以下具体目标： R21阶段：目标1将与（1）HCT提供者，（2）HCT客户，（3）PWH进行定性，形成性工作， （4）HCT和CTC客户的社交网络联系人，以确定理想的提供者-以及 基于SMS的HIV检测转介系统的客户端特征。目标2将调整我们的mParis系统， 接收索引客户确定的艾滋病毒检测转介的电话号码， HIV检测邀请函目标3将对艾滋病毒检测保密社交网络推荐系统进行试点测试 系统收集有关系统可接受性、性能和潜在功效的初步数据。 R33阶段：目标4将在一项实用的随机化研究中评价CONSORT的可接受性和有效性。 400名HCT患者和200名HIV感染CTC患者的对照试验。第1组受试者将获得 保密短信推荐和物理邀请卡（“卡推荐”），以扩展到他们的任何网络 联系人.第2组参与者将单独获得卡转介。主要结果将是艾滋病毒的吸收 试验.次要结果包括新的艾滋病毒诊断的数量，以及转诊中的风险相关性 网络.目标5将评估CONSORT+卡转诊与卡转诊的增量成本效益 一个人这项研究将提供一个例外的可接受性，有效性和成本效益的估计， 低成本的干预措施，以增加艾滋病毒检测的接受率。更广泛地说，它将开发分析和移动健康 能力，并为发展基于移动的电话的连锁转诊干预提供信息， 能够接触到关键的社交网络，可以转移到其他技术上，并且可以扩展到艾滋病毒检测之外。

UNAIDS set for 2030 the ambitious 95-95-95 target: diagnosing 95% of all persons living with HIV (PWH), initiating antiretroviral therapy for 95% of those diagnosed, and achieving viral suppression for 95% of those treated. In Tanzania, a PEPFAR strategy country with an adult HIV prevalence of 4.8%, only 83% of PWH are aware of their status. More than 200,000 undiagnosed PWH need to test in order to reach the “first 95”. With the cost-effectiveness of traditional HIV testing approaches declining, we propose to evaluate a novel application of mobile health (mHealth) technology that leverages the ubiquity of mobile phones and the reach of social networks to increase rates of HIV testing, especially among higher-risk individuals. Specifically, we will evaluate the acceptability, efficacy, and cost-effectiveness of automated, confidential, SMS-based HIV testing referrals, as a means of ‘nudging’ individuals to test. We hypothesize that an automated, confidential referral system, developed and deployed in the Kilimanjaro Region of Tanzania, will be acceptable to both index clients and their referrals and that it will be cost-effective for increasing HIV testing rates. Building on existing relationships with all 25 HIV counseling and testing (HCT) providers in the study area, including 8 HIV care and treatment centers (CTCs), and using an open-source, low-code, and highly versatile mobile phone-based appointment reminder and incentive system (mParis), this study will address the following specific aims: R21 Phase: Aim 1 will conduct qualitative, formative work with (1) HCT providers, (2) HCT clients, (3) PWH who are in care at CTCs, and (4) social network contacts of HCT and CTC clients, to identify desirable provider- and client-side characteristics of an SMS-based HIV testing referral system. Aim 2 will adapt our mParis system to receive phone numbers of HIV testing referrals identified by index clients and autonomously send confidential HIV testing invitations. Aim 3 will pilot-test the Confidential Social Network Referrals for HIV Testing (CONSORT) system to collect preliminary data on the system’s acceptability, performance, and potential efficacy. R33 Phase: Aim 4 will evaluate the acceptability and efficacy of CONSORT in a pragmatic randomized controlled trial with 400 HCT clients and 200 HIV-infected CTC patients. Arm 1 participants will be offered confidential SMS referrals and physical invitation cards (“card referrals”) to extend to any of their network contacts. Arm 2 participants will be offered card referrals alone. The primary outcome will be uptake of HIV testing. Secondary outcomes include the number of new HIV diagnoses, and the risk correlation within referral networks. Aim 5 will evaluate the incremental cost-effectiveness of CONSORT+card referrals vs. card referrals alone. The study will provide estimates of the acceptability, efficacy, and cost-effectiveness of an exceptionally low-cost intervention for increasing the uptake of HIV testing. More broadly it will develop analytic and mHealth capacity in Tanzania and inform the development of mobile phone-based chain-referral interventions that can reach key social networks, are transferrable to other technologies, and can be extended beyond HIV testing.