Implementing Assisted Partner Services to HIV Test and Treat Men in Western Kenya

在肯尼亚西部实施艾滋病毒检测和治疗男性辅助合作伙伴服务

• 批准号: 9407079
• 负责人: CAREY FARQUHAR
• 金额: $ 73.23万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-23 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9407079
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adopted; Adult; Advocate; Africa South of the Sahara; African; Attention; Caring; Clinical Research; Counseling; Country; County; Couples; Data; Diagnosis; Effectiveness; Effectiveness of Interventions; Elements; Ensure; Epidemic; Europe; Feasibility Studies; Female; Female Adolescents; Goals; Government; Guidelines; HIV; HIV Infections; HIV-infected adolescents; Health; Health care facility; Health system; Human immunodeficiency virus test; Individual; Institution; Intervention; Kenya; Knowledge; Life; Link; Measures; Methods; Modeling; Outcome; Persons; Plasma; Policy Maker; Population; Positioning Attribute; Prevalence; Principal Investigator; Public Health; Qualitative Methods; RNA; Randomized Clinical Trials; Reporting; Research; Research Personnel; Resources; Services; Sexual Partners; System; Testing; Training; Universities; Viral; Washington; Woman; Work; World Health Organization; base; case finding; control trial; cost; cost effectiveness; experience; girls; health difference; high risk; implementation science; improved; indexing; male; male health; meetings; member; men; multidisciplinary; prevent; programs; scale up; service intervention; success; transmission process; treatment program; uptake; young woman

It is estimated that >50% of HIV-infected Kenyans are unaware of their status and men are significantly less likely to test and link to care than women. Unless more attention is focused on men, Kenya and other sub- Saharan African countries with high HIV prevalence will not achieve UNAIDS 90-90-90 goals by 2020. This proposal addresses low uptake of HIV testing and poor linkage to care and treatment services among men in sub-Saharan Africa. The overarching goal is to demonstrate using implementation science methods that assisted partner services (aPS) is a safe and effective strategy to increase the proportion of men living with HIV who know their serostatus and that aPS will improve male engagement in HIV treatment programs. The study will be based in two counties in Kenya with the highest HIV prevalence in the nation: Homa Bay (27% prevalence) and Kisumu (18.7% prevalence) and be conducted by an experienced and collaborative team with an exceptionally strong track record in HIV partner testing research and implementation science in Kenya. Principal Investigator Carey Farquhar (University of Washington [UW]) will work closely with a multidisciplinary group of investigators and consultants from UW, PATH, Kenya's Ministry of Health, and the National AIDS and STI Control Program (NASCOP), and build on a successful randomized clinical trial of assisted partner services (aPS) conducted by UW and NASCOP from 2012-2015. The proposed research also leverages PATH's vast experience providing HIV testing and treatment in government facilities through the APHIAplus program, as well as PATH's recent mapping of >21,000 adolescent girls and young women for services as part of the DREAMS initiative in western Kenya. The specific aims are as follows:  AIM 1: Determine aPS effectiveness by demonstrating that aPS improves HIV testing, identifies new HIV infections, and promotes linkage, treatment and viral suppression among male partners when implemented among women and adolescent girls in government facilities in Kenya.  AIM 2: Evaluate fidelity, feasibility, and cost/cost-effectiveness when implementing aPS at 38 APHIAplus facilities and 9 “safe spaces” established by the DREAMS initiative in western Kenya. Using a mixed methods approach in this real-world setting, we will obtain data critical to national and regional scale-up. For Aim 1, we will offer aPS to more than 8,000 HIV-infected adolescent girls and women and all of their male partners; if a male partner is HIV-infected aPS will also be offered to his female partners. For Aim 2, we will use quantitative and qualitative methods to collect and evaluate data from a subset of facilities that are high and low performers, determine “necessary” elements of aPS at the level of implementation, and conduct a feasibility study, including analyses of acceptability, integration, demand, technical efficiency and cost data. In this way, the UW/PATH/MOH team will work towards building capacity in Kenya to effectively implement and sustain a model aPS program that could be replicated across sub-Saharan Africa.

据估计，50%的感染艾滋病毒的肯尼亚人不知道自己的状况，而男性明显更少 可能比女性更容易测试和联系到护理。除非更多的注意力集中在男性身上，否则肯尼亚和其他亚 到2020年，艾滋病毒感染率较高的撒哈拉非洲国家将无法实现联合国艾滋病规划署的90-90-90目标。这 提案解决了以下问题：艾滋病毒检测接受率低，与护理和治疗服务的联系不紧密 撒哈拉以南非洲的男人。首要目标是使用实施科学方法进行演示。 辅助伴侣服务(APS)是一种安全有效的战略，可以增加男性的生活比例 了解自己的血清状况的艾滋病毒携带者，APS将提高男性对艾滋病毒治疗计划的参与度。 这项研究将在肯尼亚艾滋病毒感染率最高的两个县进行：霍马湾 (27%的患病率)和18.7%的基苏木(患病率)，并由经验丰富和协作的 团队在艾滋病毒合作伙伴检测研究和实施科学方面拥有异常出色的记录 肯尼亚。首席研究员Carey Farquhar(华盛顿大学[UW])将与 由来自威斯康星大学、PATH、肯尼亚卫生部和 国家艾滋病和性传播感染控制计划(NASCOP)，并建立在成功的随机临床试验的基础上 2012-2015年，由UW和NASCOP开展的协助合作伙伴服务(APS)。拟议的研究还包括 利用Path的丰富经验，通过 APHIAplus计划，以及Path最近为21,000名青春期女孩和年轻妇女绘制的地图 服务是肯尼亚西部DREAMS倡议的一部分。具体目标如下： 目标1：通过证明AP改进艾滋病毒检测，识别新的艾滋病毒，确定AP的有效性 感染，并在实施时促进男性伴侣之间的联系、治疗和病毒抑制 在肯尼亚政府设施中的妇女和青春期女孩中。 目标2：评估在38 APHIA以上实施AP时的保真度、可行性和成本/成本效益 由梦想倡议在肯尼亚西部建立的设施和9个“安全空间”。使用混合的 方法在这一现实世界的背景下，我们将获得对国家和区域放大至关重要的数据。 对于目标1，我们将向8000多名感染艾滋病毒的青少年女孩和妇女及其所有男性提供APS 如果男性伴侣感染了艾滋病毒，也将向其女性伴侣提供APS。对于目标2，我们将 使用定量和定性方法收集和评估来自高级别设施点的数据 和业绩不佳者，在实施层面上确定APS的“必要”要素，并进行 可行性研究，包括可接受性、集成度、需求、技术效率和成本数据分析。在……里面 通过这种方式，华盛顿大学/卫生与公众服务部/卫生部小组将致力于在肯尼亚建设能力，以有效地执行和 维持一个可在整个撒哈拉以南非洲复制的示范APS计划。