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

 描述(申请人提供)：在全球范围内，尼日利亚的人数位居第二：a)艾滋病毒携带者，b)新的艾滋病毒感染者，c)艾滋病毒携带者孕妇。2013年，只有17.1%的15-49岁育龄妇女接受了艾滋病毒检测(前12个月)，尼日利亚约19万名感染艾滋病毒的孕妇中只有27%接受了预防母婴传播的抗逆转录病毒治疗(PMTCT)，相比之下，撒哈拉以南非洲(SSA)接受抗逆转录病毒治疗的孕妇总数为68%。在21个优先国家中，尼日利亚占儿童艾滋病毒新感染病例的25%(估计新增感染病例51,000例)。在SSA，大约49%的感染艾滋病毒的孕妇在产前护理登记和分娩之间失去了后续行动，45%的婴儿在艾滋病毒检测后失去了联系。尼日利亚在感染艾滋病毒的妇女和儿童中有很高的随访率(15%-56%)。2014年，我们展示了健康开始倡议(HBI)，这是一种由教会卫生团队提供的基于会众的干预措施，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使用教会组织的婴儿送礼会来吸引和识别怀孕早期的女性，将教育干预与旨在减少与仅限艾滋病毒检测相关的耻辱的综合现场实验室测试相结合。婴儿接待会有助于产后跟踪和与护理的联系。HBI解决了艾滋病毒检测的几个障碍：认为感染风险低(教育)、获得检测和治疗的机会以及费用和污名(现场、免费、综合检测)。每个社区至少有一个以信仰为基础的机构，这为评估iSTAR的有效性提供了独特的机会，iSTAR是一种以社区和诊所为基础的综合干预措施，旨在测试、联系、吸引和维持受艾滋病毒感染的妇女接受护理。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名感染艾滋病毒的妇女之间的联系、接触、保留和病毒抑制。在EPIS框架的基础上，我们将使用社交网络干预方法来促进实施，并评估实施领导和背景。尼日利亚南部的50座教堂将被随机分配(1：1)给iSTAR或CG。ISTAR干预措施提供：在婴儿送礼会期间进行保密的现场综合实验室检测；教会健康顾问网络；诊所团队接受励志访谈培训；提高质量技能，以吸引和支持感染艾滋病毒的妇女；以及综合病例管理，以减少后续行动的损失。主要结果是iSTAR和CG之间的联系和参与率的差异。次要结果是滞留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)、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(可持续发展评估)、内华达州立学院(统计分析和调解/协调分析)和内华达大学拉斯维加斯分校(全面监督项目实施和评估)之间的合作。

 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).