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%的艾滋病毒携带者(PWH)， 为95%的确诊患者启动抗逆转录病毒治疗，并为95%的患者实现病毒抑制 治疗过了。在坦桑尼亚，一个PEPFAR战略国家，成人艾滋病毒感染率为4.8%，只有83%的PWH是 了解他们的状态。20多万名未确诊的PWH患者需要进行检测才能达到“首批95名”。 随着传统艾滋病毒检测方法的成本效益下降，我们建议评估一种新的 应用移动健康(MHealth)技术，利用移动电话的普及性和 社会网络，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、基于短信的艾滋病毒检测的可接受性、有效性和成本效益 推荐，作为“轻推”个人进行测试的一种手段。我们假设一个自动的、保密的推荐 在坦桑尼亚乞力马扎罗地区开发和部署的系统将为两个指数客户所接受 和他们的转介，这将是提高艾滋病毒检测率的成本效益。在现有基础上构建 与研究地区所有25个艾滋病毒咨询和检测提供者的关系，包括8个艾滋病毒护理和 治疗中心(CTC)，并使用基于开源、低代码和高度通用的移动电话 关于预约提醒和奖励制度(巴黎)，本研究将探讨以下具体目标： R21阶段：目标1将与(1)HCT提供者、(2)HCT客户、(3)PWH WHO进行定性、形成性工作 在CTC得到照顾，以及(4)HCT和CTC客户的社交网络联系人，以确定理想的提供商-以及 基于短信的HIV检测转诊系统的客户端特点。目标2将使我们的mParis系统适应 接收索引客户端识别的艾滋病毒检测转诊的电话号码，并自主发送机密 艾滋病毒检测邀请函。AIM 3将试行HIV检测的保密社交网络转介(CONSORT) 系统收集有关系统的可接受性、性能和潜在功效的初步数据。 R33阶段：目标4将在语用随机调查中评估COSORT的可接受性和有效性 对400名HCT患者和200名感染HIV的CTC患者进行对照试验。将向ARM 1参与者提供 机密短信推荐和实体邀请卡(“卡推荐”)扩展到他们的任何网络 联系人。ARM 2参与者将单独获得卡片推荐。主要结果将是感染艾滋病毒 测试。次要结果包括新诊断艾滋病毒的数量和转诊内的风险相关性 网络。目标5将评估Conort+卡转诊与卡转诊的增量成本效益 独自一人。这项研究将提供可接受性、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度。更广泛地说，它将发展分析型和移动健康 坦桑尼亚的能力，并为发展基于移动电话的连锁转介干预措施提供信息，这些干预措施可以 接触到关键的社交网络，可以转移到其他技术，并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.