VCT with Primary and Concurrent Partners to Prevent HIV Transmission

与主要和同时性伴侣进行 VCT，以预防 HIV 传播

• 批准号: 8602859
• 负责人: Susan A Allen
• 金额: $ 51.24万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-21 至 2016-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8602859
• 关键词: AIDS Vaccines; AIDS prevention; Adherence; Adult; Advocacy; Africa; African; Antibodies; Attitude; Behavior Therapy; Biological Assay; Cities; Clinic; Clinical Trials; Comprehension; Consensus; Counseling; Couples; DNA; Data; Data Collection; Detection; Development; Enzyme-Linked Immunosorbent Assay; Epidemic; Epidemiology; Ethics; Evaluation; Family; Female; Frequencies; Funding; Future; Goals; Government; HIV; HIV Infections; HIV risk; Immunogenetics; Immunologics; Immunology; Incidence; Infection; International; International AIDS; Intervention; Joints; Laboratories; Male Circumcision; Marriage; Measures; Nature; Nurses; Participant; Phase; Polygamy; Preparation; Prevention; Prevention Research; Prevention program; Prevention strategy; Procedures; Process; Professional counselor; Prostitution; Province; Publishing; RNA; Randomized; Reporting; Research; Rwanda; Sample Size; Sampling; Seasons; Services; Site; Southern Africa; Spouses; Testing; Vaccines; Viral Genome; Virus; Visit; Wife; Woman; Zambia; base; cohort; contagion; efficacy testing; experience; group intervention; high risk; loved ones; male; men; prevent; professor; service intervention; sex; tool; transmission process; urban area; virology

DESCRIPTION (provided by applicant): In preparation for future trials of biomedical and behavioral interventions, it is critical to establish HIV incidence in high risk cohorts who have benefited from the best, most affordable prevention programs available to them locally. Three-quarters of African adults are in cohabiting unions, where most new infections occur. "One Love" campaigns promote monogamy, but unless both partners in a sexual dyad - whether married or concurrent - have the same infection status, being faithful is not protective. In this application, Couples' Voluntary HIV Counseling and Testing (CVCT) provided to cohabiting couples in Zambian government clinics will be extended to concurrent partners, and the impact of joint testing on incidence of HIV acquired within and outside the union will be measured. Discordant couples are critical to HIV prevention research: They allow study of virologic, immunologic and immunogenetic correlates of 'contagion' and 'vulnerability' in male-to-female and female-to-male transmission, and testing of biomedical and behavioral interventions in both HIV+ and HIV- partners. Comparison of transmitted viruses in donor and recipient clarify the selection process that a vaccine must overcome. Comparison of HIV incidence in several East-Central African observational discordant couple cohorts with (3.5/100 PY) and without (10.2/100 PY) CVCT yields an estimated reduction of two-thirds. In counseled discordant couples in Lusaka, Zambia, HIV incidence between spouses is 6/100 PY, and an additional 1.5/100 PY are infected by concurrent partners. Only one small published study of uncounseled Zambian discordant couples is available and reported an incidence of 21/100 PY, thus there is less consensus about the effect size of CVCT in southern Africa. Aim 1 will examine the incidence and origin of infections acquired prior to CVCT using viral genome testing and will quantify the prevention impact of CVCT in discordant couples. UNAIDS and DHS data indicate that most extramarital contacts are with longstanding steady partners. The potential impact of joint testing with concurrent partners (CPT) on HIV infections acquired outside marriage in both discordant and concordant negative couples has not been explored. A formative evaluation phase will precede development (Aim 2) of a CPT intervention adapted from CVCT procedures developed under RO1 MH 66767. Forty clinics with CVCT services managed by the research team will be randomized to provide CPT (Aim 3). The incidence of new infections acquired outside marriage will be compared in the CVCT only vs. CVCT+CPT clinics. Despite counseling and free services, only 10% of discordant couples with HIV- male partners request male circumcision (MC). Like CVCT, MC is a locally affordable and proven prevention strategy which must be offered to participants in future trials. Ancillary Aim 4 will investigate obstacles to male circumcision (MC) to optimize adherence with ethical standards in future trials.

描述（由申请人提供）：在为将来的生物医学和行为干预试验做准备时，确定艾滋病毒在高风险人群中的发病率是至关重要的，这些人群受益于当地最好、最负担得起的预防方案。四分之三的非洲成年人是同居伴侣，大多数新感染都发生在同居伴侣中。“一心一爱”运动提倡一夫一妻制，但除非性伴侣中的双方——无论是已婚还是同居——都有相同的感染状况，否则忠诚并不能起到保护作用。在这项申请中，在赞比亚政府诊所为同居伴侣提供的“夫妻自愿艾滋病毒咨询和检测”（CVCT）将扩展到同居伴侣，并测量联合检测对夫妻双方感染艾滋病毒的影响。不和谐夫妻对艾滋病毒预防研究至关重要：他们允许研究男性向女性和女性向男性传播的“传染”和“脆弱性”的病毒学、免疫学和免疫遗传学相关因素，并测试艾滋病毒阳性和艾滋病毒感染伴侣的生物医学和行为干预措施。在供体和受体中传播病毒的比较阐明了疫苗必须克服的选择过程。在几个中东部非洲观察性不一致夫妇队列中，有（3.5/100 PY）和没有（10.2/100 PY） CVCT的艾滋病毒发病率进行比较，估计减少了三分之二。在赞比亚卢萨卡接受咨询的不和谐夫妇中，配偶之间的艾滋病毒感染率为6/100 PY，另有1.5/100 PY被同居伴侣感染。只有一项针对未接受咨询的赞比亚不和谐夫妇的小型已发表研究，报告的发病率为21/100 PY，因此，关于CVCT在南部非洲的效应大小的共识较少。目的1将使用病毒基因组检测检查在CVCT之前获得的感染的发生率和起源，并将量化CVCT在不一致夫妇中的预防作用。联合国艾滋病规划署和国土安全部的数据表明，大多数婚外性接触都是与长期稳定的伴侣发生的。同时性伴侣联合检测（CPT）对不和谐和和谐阴性夫妇婚外感染HIV的潜在影响尚未探讨。形成性评估阶段将在根据RO1 MH 66767制定的cct程序改编的CPT干预措施（目标2）之前进行。由研究小组管理的40家提供cct服务的诊所将被随机分配提供CPT（目标3）。婚外获得新感染的发生率将在仅采用cct和采用cct +CPT的诊所进行比较。尽管有咨询和免费服务，但只有10%的男性感染艾滋病毒的不一致夫妇要求进行男性包皮环切。与CVCT一样，MC是一种当地负担得起的、经过验证的预防策略，必须在未来的试验中向参与者提供。辅助目标4将调查男性包皮环切术（MC）的障碍，以在未来的试验中优化对伦理标准的遵守。