Impact Evaluation of Combination HIV Prevention Interventions in Botswana

项目摘要/摘要 这项建议是为了评估联合艾滋病毒的影响和成本效益 预防干预措施在博茨瓦纳的人口水平艾滋病毒发病率，一个严重的国家 普遍的艾滋病毒流行。尽管成年人的感染率为25%，但博茨瓦纳在以下方面领先于非洲 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个 截然不同的、随机的农村社区，以实现艾滋病毒检测的联合预防目标 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CD4d250和预防母婴传播(母婴传播)。 8个控制社区(ARM A)和8个强化组合预防社区(ARM B)将对艾滋病毒发病率进行比较，预计在研究期间将减少50% 对于手臂B，Mochudi的第三个(手臂C)将提供阶梯楔形设计，有6个社区 为高病毒携带者(“高病毒携带者”)增加3种药物的抗逆转录病毒药物干预 以及在手臂B中使用的增强联合预防干预措施，我们 预期将更大程度地降低艾滋病毒发病率。 所有ARM将评估这项为期4年的研究中的艾滋病毒发病率。B和C臂也将 包括广泛的额外活动，例如：社区动员和教育，加强 HTC，流动夜间诊所，与各种社区组织的联动，以及合作伙伴测试； 额外的检测技术，如医疗保健点CD4检测，以检测更大比例的患者 谁有资格接受抗逆转录病毒治疗和防止母婴传播；以及更早地启动抗逆转录病毒治疗并加强对 同样的人口。对于抗逆转录病毒治疗和防止母婴传播，我们预计我们的目标将超过 RFA。 博茨瓦纳-哈佛伙伴关系(BHP)是一个非营利性组织，根据 博茨瓦纳的法律，基于哈佛大学和博茨瓦纳大学之间长达15年的官方合作。 博茨瓦纳卫生部。除了作为最初的来源机构来开发 博茨瓦纳防治艾滋病紧急救援计划和国家抗逆转录病毒治疗方案，以及与艾滋病有关的最大 在国家的培训计划中，必和必拓进行了科学研究，并广泛 出版了RFA中涉及的所有主要预防干预措施。必和必拓还拥有 大容量认可实验室，位于研究地点的中心位置，作为 艾滋病毒/艾滋病国家参考实验室。

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.