Impact Evaluation of Combination HIV Prevention Interventions in Botswana

项目概要/摘要 该建议是为了评估联合艾滋病毒的影响和成本效益 博茨瓦纳是一个艾滋病毒感染严重的国家， 普遍的艾滋病流行。尽管在成年人中有25%的患病率，博茨瓦纳在非洲 扩大艾滋病毒预防和治疗的若干干预措施。该提案将使用16 不同的随机农村社区，以实现艾滋病毒检测的综合预防目标 和咨询（HTC），成年男性包皮环切术（MC），抗逆转录病毒治疗（ART）， 艾滋病患者或CD 4 d 250，以及预防母婴传播（PMTCT）。 8个对照社区（A组）和8个加强联合预防社区（A组） 将比较B）的HIV发病率，预计在研究期间降低50% 对于臂B。Mochudi的第三个项目（C组）将提供一个有6个社区的阶梯楔形设计， 为高病毒载量个体（“高病毒载量携带者“）增加3种药物的ART干预 沿着在B组中使用的强化联合预防干预，我们 预计将进一步降低艾滋病毒的发病率。 所有组将评价4年研究期间的HIV发病率。臂B和C还将 包括广泛额外活动，例如：社区动员和教育，加强 HTC、移动的夜间诊所、与各社区组织的联动、以及合作伙伴检测; 额外的检测技术，如即时CD 4检测，以检测更大比例的患者 有资格接受抗逆转录病毒治疗和预防母婴传播的人;以及更早开始抗逆转录病毒治疗和加强对 相同的人口。在抗逆转录病毒疗法和防止母婴传播方面，我们预期目标会超过 射频消融 博茨瓦纳-哈佛伙伴关系（BHP）是一个非营利组织， 博茨瓦纳的法律，并基于哈佛和 博茨瓦纳卫生部。除了作为原始源机构开发 博茨瓦纳PEPFAR和国家ART计划，以及最大的艾滋病相关 在该国的培训计划，必和必拓进行了科学研究，并广泛 出版了关于《外地住房储备金》中涉及的所有主要预防干预措施的报告。必和必拓也有一个 大容量认证实验室，位于研究中心的中心位置， 国家艾滋病参考实验室。

PROJECT SUMMARY/ABSTRACT This proposal is to evaluate the impact and cost effectiveness of combination HIV prevention interventions on population-level HIV incidence in Botswana, a country with a severe generalized HIV epidemic. Despite a 25% prevalence in adults, Botswana has led Africa in scale-up of several interventions for HIV prevention and treatment. The proposal will use 16 distinct, randomized rural communities to meet combination prevention goals of HIV Testing and Counseling (HTC), adult male circumcision (MC), AntiRetroviral Therapy (ART) for patients with AIDS or CD4 d 250, and Prevention of Mother-to-Child Transmission (PMTCT). Eight control communities (Arm A) and 8 enhanced combination-prevention communities (Arm B) will be compared for HIV incidence, anticipating a reduction of e 50% over the study period for Arm B. A third (Arm C) in Mochudi will provide a step-wedge design with 6 communities to add a 3-drug ART intervention for individuals with high viral-load ("high viral load carriers ") along with the enhanced combination prevention interventions used in Arm B, which we anticipate will provide even greater reductions in HIV incidence. All arms will evaluate HIV incidence over the 4-year study. Arms B and C will also include extensive extra activities, such as: community mobilization and education, enhanced HTC, mobile night clinics, linkage with various community organizations, and partner testing; extra testing techniques such as point-of-care CD4 testing to detect a larger fraction of patients who qualify for ART and PMTCT; and earlier ART initiation and enhanced monitoring of the same populations. For ART and PMTCT, we expect our targets to exceed those indicated in the RFA. The Botswana-Harvard Partnership (BHP) is a not-for-profit organization chartered under the laws of Botswana, and is based upon a 15-year official collaboration between Harvard and the Botswana Ministry of Health. In addition to serving as the original source agency to develop the Botswana PEPFAR and the National ART Program, as well as the largest AIDS-related training program in the country, the BHP has conducted scientific studies and extensively published on all the major prevention interventions addressed in the RFA. The BHP also has a large-capacity accredited laboratory that is central in location to the study sites and serves as the national reference lab for HIV/AIDS.