Evaluating Demand Generation (Stylish Man) for HIV/Family Planning Services Rakai

评估艾滋病毒/计划生育服务的需求生成（时尚男士） Rakai

• 批准号: 8790046
• 负责人: Maria J Wawer
• 金额: $ 82.81万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8790046
• 关键词: AIDS prevention; Abate; Adoption; Africa; African; Attenuated; Awareness; Behavior; Behavior Therapy; Behavioral; Biological Assay; Blood; Caring; Censuses; Charge; Child; Client; Clinic; Cohort Studies; Collaborations; Communities; Consent; Counseling; Data; Disease Progression; Elements; Epidemic; Event; Family Planning; Fishes; Funding; Gender; Gender Identity; Generations; Goals; Grant; HIV; HIV Infections; Health; Health Sciences; Health Services Accessibility; Health Status; Health education; Incidence; Individual; Intervention; Life; Male Circumcision; Male Condoms; Mass Media; Medical; Metric; Modeling; Monitor; Mothers; Muslim population group; National Institute of Child Health and Human Development; Outcome; Peer Pressure; Perception; Population; Pregnant Women; Prevalence; Prevention; Prevention program; Prophylactic treatment; Qualitative Research; Radio; Relative (related person); Reproductive Health; Risk; Risk Behaviors; Rural; Service Statistics; Services; Site; Stress; Surveys; Testing; Time; Uganda; Vertical Disease Transmission; Woman; aged; antiretroviral therapy; arm; base; condoms; design; disease transmission; dissemination research; evidence base; high risk; implementation research; improved; innovation; intervention program; male; man; men; novel; novel strategies; posters; prevent; prevention service; primary outcome; programs; public health relevance; randomized trial; response; scale up; secondary outcome; social; social cognitive theory; theories; trend; uptake

DESCRIPTION (provided by applicant): In response to PAR-13-055 for Dissemination and Implementation Research in Health, we propose to test a novel demand generation strategy, the "Stylish Man", to increase uptake of Combined HIV Prevention (CHP) in Rakai, Uganda. CHP includes evidence-based biomedical interventions, including safe male circumcision (SMC), antiretroviral therapy (ART) and prevention of mother to child transmission (p-MTCT), as well as behavioral interventions. CHP may substantially attenuate the HIV epidemic; however, optimal effects require high rates of CHP coverage. With PEPFAR funds, the Rakai Health Sciences Program (RHSP) provides CHP in Rakai District, Uganda. Our ongoing 54 village Rakai Community Cohort Study (RCCS), with community HIV prevalence ranging from 6% to 42%, provides longitudinal data on rates of CHP coverage, including SMC, ART and p-MTCT; risk behaviors; and HIV incidence. We have preliminary evidence that CHP is reducing HIV incidence in Rakai, but coverage remains suboptimal (as elsewhere in Africa), particularly in men, reducing program impact. Our data suggest that CHP supply is not the limiting factor, but that there is a "deficit in demand". We conducted extensive qualitative research and identified barriers to CHP uptake, which were most pronounced among men. Based on these data as well as social cognitive theory and the social ecological model, we developed and piloted an innovative male-focused CHP demand generation strategy, the "Stylish Man Program" (SMP) which is male-friendly without excluding exclude women. The SMP strives to "demedicalize" CHP by deemphasizing health-focused messages and instead stressing "taking charge of your life". The SMP has two distinct but related elements: (1) mass media (MM) via radio and posters; and (2) community-level mobilization via the "Stylish Man Event" (SMEvent) which includes entertainment and contests with embedded CHP promotion, and immediate access to services. Pilot data are encouraging (ex., a fourfold increase in the number of male circumcision clients coming to RHSP mobile clinics compared to prior service statistics). We propose to conduct a 3 year cluster randomized trial of MM plus SMEvents (intervention arm) compared to MM alone (control), in 25 RCCS communities aggregated into ~12 clusters per arm (50 communities in all). The primary outcome will be intent-to-treat community-level rates of CHP coverage (focus on ART, SMC, p-MTCT) by arm. We will also monitor rates of key behaviors and HIV incidence, and compare them between arms and to rates observed in communities in each arm prior to study initiation. Secondary outcomes will thus be time trends in HIV incidence, key behaviors and CHP coverage in each arm prior to and during the study. We have PEPFAR funding for all the CHP services. The design optimizes efficiency and will rapidly provide data on the effects of innovative demand generation for other CHP programs in Africa.

描述（由申请人提供）：为了响应PAR-13-055的传播和实施研究在健康，我们建议测试一种新的需求生成策略，“时尚的人”，以增加艾滋病毒综合预防（CHP）在Rakai，乌干达的吸收。卫生保健方案包括循证生物医学干预措施，包括安全男性包皮环切术、抗逆转录病毒疗法和预防母婴传播，以及行为干预措施。卫生防护中心可以大大减少艾滋病毒的流行，但是，最佳效果需要卫生防护中心的高覆盖率。在总统艾滋病紧急救援计划的资助下，Rakai卫生科学方案在乌干达Rakai地区提供卫生保健方案。我们正在进行的54个村庄Rakai社区队列研究（RCCS），社区艾滋病毒流行率从6%到42%不等，提供了关于CHP覆盖率的纵向数据，包括SMC，ART和p-MTCT;风险行为;和艾滋病毒发病率。我们有初步证据表明，卫生防护中心正在降低拉凯的艾滋病毒发病率，但覆盖率仍然不理想（与非洲其他地方一样），特别是在男性中，降低了计划的影响。我们的数据表明，热电联产供应不是限制因素，但存在“需求不足”。 我们进行了广泛的定性研究，并确定了CHP吸收的障碍，这在男性中最为明显。基于这些数据以及社会认知理论和社会生态模型，我们开发并试行了一种创新的以男性为中心的热电联产需求生成策略，即“时尚男士计划”（SMP），该计划对男性友好，但不排斥女性。SMP努力通过不强调以健康为重点的信息，而强调“对你的生活负责”，使CHP“去医疗化”。该战略计划有两个不同但相关的要素：（1）通过电台和海报的大众媒体;（2）通过“时尚男士活动”在社区一级进行动员，其中包括娱乐和竞赛，并嵌入卫生防护中心的宣传，以及立即获得服务。试点数据令人鼓舞（例如，到生殖健康保健项目移动的诊所接受包皮环切手术的人数比以前的服务统计数字增加了四倍）。我们建议在25个RCCS社区中进行一项为期3年的MM加SMEvents（干预组）与MM单独（对照组）的随机分组试验，每组约12个集群（共50个社区）。主要结果将是按组列出的社区层面CHP覆盖率（重点是ART、SMC、p-MTCT）的意向治疗率。我们还将监测关键行为率和HIV发病率，并将其在组间进行比较，并与研究开始前在每个组的社区中观察到的比率进行比较。因此，次要结局将是研究前和研究期间每组中HIV发病率、关键行为和CHP覆盖率的时间趋势。我们为所有的卫生防护中心服务提供PEPFAR资金。该设计优化了效率，并将迅速提供有关非洲其他热电联产项目创新需求产生效果的数据。