Intervention for Sustained Testing and Retention (iSTAR) Among HIV-infected Patients

HIV 感染者持续检测和保留干预 (iSTAR)

• 批准号: 9337549
• 负责人: Echezona Edozie Ezeanolue
• 金额: $ 25.5万
• 依托单位: UNIVERSITY OF NEVADA LAS VEGAS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-02 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9337549
• 关键词: 15 year old; Accounting; Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; Attitude; B-Lymphocytes; Behavior; California; Caring; Case Management; Chicago; Child; Childhood; Church; Clergy; Climate; Clinic; Clinical; Cluster randomized trial; Collaborations; Communities; Continuity of Patient Care; Control Groups; Country; Development; Diagnosis; Educational Intervention; Effectiveness; Effectiveness of Interventions; Evaluation; Female of child bearing age; Funding; Funding Agency; Generations; Genotype; Goals; HIV; HIV Infections; HIV diagnosis; Health; Hepatitis B; Human immunodeficiency virus test; Individual; Infant; Infection; Institution; Intervention; Laboratories; Leadership; Life; Link; Maintenance; Mediation; Methods; Mother-to-child HIV transmission; Nevada; Nigeria; Outcome; Participant; Pathway Analysis; Patients; Perception; Phase; Policy Maker; Pregnancy; Pregnant Women; Preparation; Prevention; Prevention program; Randomized; Resources; Risk; Sickle Cell; Site; Social Network; Staging; Testing; Training; Treatment Cost; Universities; Viral; Viral Load result; Woman; antiretroviral therapy; base; care delivery; cohesion; college; comparative effectiveness; design; education access; effectiveness trial; follow-up; implementation science; motivational enhancement therapy; primary outcome; programs; retention rate; secondary outcome; skills; social stigma; trial design

 DESCRIPTION (provided by applicant): Globally, Nigeria has the 2nd largest number of: a) people living with HIV, b) new HIV infections, and c) pregnant women living with HIV. In 2013 only 17.1% of women of childbearing age 15-49 years received an HIV test (preceding 12-months) and only 27% of the estimated 190,000 HIV-infected pregnant women in Nigeria who delivered babies received antiretroviral therapy for prevention of mother-to-child HIV transmission (PMTCT), compared to 68% of pregnant women receiving ART overall in sub-Saharan Africa (SSA). Nigeria accounts for 25% of new childhood HIV infections among the 21 priority countries (estimated 51,000 new infections). Roughly 49% of HIV-infected pregnant women in SSA are lost to follow up between registration in antenatal care and delivery, and 45% of infants are lost after HIV testing. Nigeria has high loss to follow-up (15%-56%) among HIV-infected women and children. In 2014, we demonstrated that the Healthy Beginning Initiative (HBI), a congregation-based intervention delivered by church-based health teams, was more effective in increasing HIV testing among pregnant women compared to a clinic-based approach. HBI uses church organized baby showers to engage and identify women early in pregnancy, combines educational intervention with integrated, on-site laboratory testing designed to reduce stigma associated with HIV-only testing. Baby receptions facilitate post-delivery follow-up and linkage to care. HBI addresses several barriers to HIV testing: perception of low risk to infection (education), access to testing and treatment, and cost and stigma (on-site, free, integrated testing). At least one faith-based institution is in each community, presenting a unique opportunity to evaluate the effectiveness of iSTAR, an integrated community and clinic based intervention that is designed to test, link, engage and sustain HIV-infected women in care. We propose a cluster randomized comparative effectiveness trial of iSTAR versus a clinic-based approach (CG). We will assess linkage, engagement, retention and viral suppression among 400 HIV-infected women. Based on the EPIS framework, we will use social network intervention methods to facilitate implementation and also assess implementation leadership and context. Fifty churches in south-south Nigeria will be randomly assigned (1:1) to iSTAR or CG. The iSTAR intervention provides: confidential, onsite integrated laboratory testing during baby showers; a network of church-based health advisors; clinic based teams trained in motivational interviewing; quality improvement skills to engage and support HIV-infected women; and integrated case management to reduce loss to follow-up. Primary outcomes are difference in linkage and engagement rates between iSTAR and CG. Secondary outcomes are difference in retention and viral suppression rate. This proposal is a collaboration among University of Nigeria (PEPFAR-funded partner in Nigeria [training and local project oversight]; University of Southern California (network analysis); UC San Diego (implementation science); UIC Chicago (assessment of sustainment); Nevada State College (statistical analyses and mediation/moderation analysis), and University of Nevada, Las Vegas (overall oversight of program implementation and evaluation).

 描述（由申请人提供）：在全球范围内，尼日利亚的以下人数排名第二：a) 艾滋病毒感染者，b) 新发艾滋病毒感染者，以及 c) 艾滋病毒孕妇感染者。 2013 年，只有 17.1% 的 15-49 岁育龄妇女接受了艾滋病毒检测（12 个月前），尼日利亚估计有 190,000 名艾滋病毒感染孕妇分娩后，只有 27% 接受了抗逆转录病毒治疗以预防艾滋病毒母婴传播 (PMTCT)，而撒哈拉以南非洲地区接受抗逆转录病毒治疗的孕妇总数为 68% （SSA）。在 21 个重点国家中，尼日利亚占新增儿童艾滋病毒感染人数的 25%（估计新增感染人数为 51,000 人）。 SSA 中大约 49% 的感染 HIV 的孕妇在产前护理登记和分娩之间失访，45% 的婴儿在 HIV 检测后失访。尼日利亚感染艾滋病毒的妇女和儿童的失访率很高（15%-56%）。 2014 年，我们证明，健康起点计划 (HBI) 是一种由教会卫生团队提供的以会众为基础的干预措施，与基于诊所的方法相比，在增加孕妇艾滋病毒检测方面更有效。 HBI 利用教会组织的婴儿送礼会来吸引和识别怀孕早期的女性，将教育干预与综合的现场实验室检测相结合，旨在减少与仅艾滋病毒检测相关的耻辱。婴儿接待有助于产后跟进和护理联系。 HBI 解决了 HIV 检测的几个障碍：感染风险低的认知（教育）、获得检测和治疗的机会以及成本和耻辱（现场、免费、综合检测）。每个社区至少有一个基于信仰的机构，为评估 iSTAR 的有效性提供了独特的机会，iSTAR 是一种基于社区和诊所的综合干预措施，旨在测试、联系、吸引和维持接受护理的艾滋病毒感染妇女。我们提出了一项 iSTAR 与基于临床的方法 (CG) 的整群随机比较有效性试验。我们将评估 400 名 HIV 感染女性的联系、参与、保留和病毒抑制。基于EPIS框架，我们将使用社交网络干预方法来促进实施，并评估实施领导力和背景。尼日利亚南南部的 50 个教堂将被随机分配（1:1）到 iSTAR 或 CG。 iSTAR 干预措施提供： 迎婴派对期间的保密现场综合实验室测试；以教会为基础的健康顾问网络；接受过动机访谈培训的诊所团队；吸引和支持艾滋病毒感染妇女的质量改进技能；综合案例管理以减少后续损失。主要结果是 iSTAR 和 CG 之间的联系和参与率的差异。次要结果是保留率和病毒抑制率的差异。该提案是尼日利亚大学（PEPFAR 资助的尼日利亚合作伙伴[培训和当地项目监督]、南加州大学（网络分析）、加州大学圣地亚哥分校（实施科学）、UIC 芝加哥分校（维持评估）、内华达州立学院（统计分析和调解/调节分析）和内华达大学拉斯维加斯分校（项目实施和评估的总体监督）之间的合作。