Community HIV Testing and Linkage to Care in Uganda

描述（由申请人提供）：在乌干达，15-49岁人群的艾滋病毒感染率估计超过7%，并且呈上升趋势。然而，只有21%的乌干达人知道自己的艾滋病毒血清状况。最近，乌干达和撒哈拉以南非洲地区的社区艾滋病毒检测有所增加，有望有效地惠及未接受医疗保健检测的高风险农村和移民社区的个人。在乌干达，大多数社区检测是在临时流动场所提供的，可以覆盖大量人群（每天多达1900人）。然而，社区检测对诊断后及时联系护理提出了相当大的挑战。在农村地区，检测呈阳性的人可能会被转诊到数公里外的诊所；未铺设的道路加上缺乏足够的交通可能会阻碍求医。对于高风险移民人群，如贸易/市场社区的人（他们经常迁移到该地区的不同市场）或渔民（他们大部分时间都在离家捕鱼，并且在不同的湖岸地点有多个着陆点），转诊治疗尤其困难。我们建议使用迭代混合（定性和定量）方法系统地探索与护理联系的障碍和促进因素，最终开发出可在不同社区测试场所扩大规模的新颖解决方案。具体目标是：(1)利用定性方法了解三种不同类型的社区艾滋病毒检测环境（农村、贸易社区、渔业社区）的组织方案、与护理联系的障碍和促进因素，以及潜在的新解决方案；(2)定量考察不同社区HIV检测机构中新诊断HIV感染者与医护联动的障碍和促进因素。在第一阶段，我们将与开展社区检测的社区组织的主要利益相关者进行10次定性访谈，并在高风险社区（贸易社区、渔业社区、农村）观察三种不同的检测场景，以了解当前的检测和转诊方案。我们还将对30名测试结果呈阳性的个人进行定性访谈，以探索与护理联系的潜在障碍和促进因素。在第二阶段，我们将定量和纵向地检查240名艾滋病毒检测呈阳性的个体（每个检测点类型80人）的样本中与护理联系的障碍和促进因素，以及接受护理的时间。在第三阶段，我们将采用迭代过程，对5个主要利益相关者（来自第一阶段）和18个艾滋病毒检测呈阳性的客户（来自第二阶段）进行额外的定性访谈，以获取关于第一阶段和第二阶段结果意义的反馈，并为在收到社区艾滋病毒检测阳性结果后与护理联系的创新解决方案提供意见。

DESCRIPTION (provided by applicant): In Uganda, HIV prevalence is estimated to be over 7% among those aged 15-49 and is rising. Yet, only 21% of Ugandans are aware of their HIV-serostatus. Community HIV testing has increased in Uganda and sub- Saharan Africa recently, and holds promise in efficiently reaching individuals from high-risk rural and migrant communities that are not touched by healthcare-based testing. In Uganda, most community testing is delivered in temporary, mobile venues, and can reach large numbers of people (up to 1,900 per day). Nevertheless, community testing presents considerable challenges for timely linkage to care after diagnosis. In rural settings, people who test positive may be referred to clinics many kilometers away; unpaved roads combined with lack of adequate transportation may deter care- seeking. Referral to care is especially difficult for high-risk migrant populations such as people in trading/market communities (who frequently move to different markets across the region), or fisherfolk (who spend most of the time fishing away from home, and who have multiple landing sites at different lakeshore locations). We propose to systematically explore barriers to and facilitators of linkage to care using iterative mixed (qualitative and quantitative methods, to ultimately develop novel solutions that are feasible for scale-up in diverse community testing venues. The specific aims are: (1) to use qualitative methods to understand the organizational protocol for, barriers to, and facilitators of linkage to care, and potential noel solutions, in three different types of community HIV testing settings (rural villages, trading communities, fishing communities); and (2) to examine quantitatively the barriers to and facilitators of linkage to care among people newly diagnosed with HIV at different community HIV testing settings. In Phase 1, we will conduct 10 qualitative interviews with key stakeholders in community-based organizations that conduct community testing, and observe three diverse testing scenarios in high-risk communities (trading communities, fishing communities, rural villages) to understand the current protocol for testing and referrals to care. We will also conduc qualitative interviews with 30 individuals who receive a positive test result to explore potential barriers to and facilitators of linkage to care. In Phase 2, we will quantitatively and longitudinaly examine barriers to and facilitators of linkage to care, as well as time to receipt of care, among sample of 240 individuals who test positive for HIV (80 per testing site type). In Phase 3, using an iterative process, we will conduct additional qualitative interviews with 5 key stakeholders (from Phase 1) and 18 HIV-positive testing clients (from Phase 2), in order to elicit feedback about the meaning of the Phase 1 and Phase 2 results, and input on innovative solutions for linkage to care following receipt of a positive test result in community HIV testing.