Self-Test Strategies and Linkage Incentives to Improve ART and PrEP Uptake in Men

项目摘要 要结束撒哈拉以南非洲的艾滋病流行，就需要男子进一步参与艾滋病毒检测、预防， 这是一项具有挑战性的任务，因为许多国家近50%的艾滋病毒阳性男子不知道 艾滋病毒感染者和男性接受艾滋病毒抗逆转录病毒治疗和暴露前预防的人数较少 （PrEP）。这项研究的重点是一个高度移动的人口的男子-渔民-在肯尼亚的维多利亚湖 沿海社区的艾滋病毒感染率极高。最近的两项创新-艾滋病毒自我- 艾滋病毒检测（HIVST）和基于社会网络的干预措施-有望克服艾滋病毒检测的障碍 以及与为艾滋病毒阳性和阴性男子提供的服务挂钩。这项研究旨在确定艾滋病毒是否 地位中立、基于社会网络的方法，加上沿着低成本的激励措施，可以促进艾滋病毒检测， 保健和预防之间的联系，以及改善男子的健康状况。它将追求三个目标： 目标1：确定是否向网络中心的男子提供艾滋病毒自我检测，以便分发给其他男子 在其密切的社交网络中，艾滋病毒检测的使用率增加。我们将进行社交网络 在肯尼亚锡亚亚县的研究社区中绘制地图，以确定男子独特的密切社交网络。 然后，我们将这些社交网络随机分为干预组和对照组。网络中心，高度- 每个网络中有联系的男子将被招募为“宣传员”，并接受艾滋病毒/艾滋病防治培训。启动子 然后，分配给干预行动的网络将接受自我测试，以分发给其网络中的男子。 分配给控制的网络中的促销员将在附近的 健康诊所。我们假设在接受干预的网络中，男性的艾滋病毒检测率较高。 目标2：确定网络中心的促进者和小的激励措施是否可以增加ART和PrEP 男人之间的吸引力。我们将测试网络中心启动子是否可以增强与ART和PrEP的联系 自我检测后，从而解决了艾滋病毒的一个关键限制。Aim 1干预组的宣传员 将被要求向其网络中的男性分发抗逆转录病毒疗法或预防性预防措施的信息和交通券。我们 主要假设是，干预将导致与ART或PrEP的关联率更高（确证性 检测和ART转介阳性，和PrEP筛查阴性）。我们还假设， 在分配到干预组的社交网络中，男性在3个月内的PrEP摄取率。 目标3：测试干预措施对ART或PrEP保留和依从性的影响。我们将测量6- 和12个月的VL和替诺福韦水平，使用最近开发的低成本，护理点PrEP坚持 尿免疫测定在所有目标中，我们将使用定性和混合方法来确定途径 干预行动，并了解社交网络和激励措施如何影响测试和ART和PrEP 吸收和保留。这项研究承诺高科学和公共卫生的影响，通过测试新的 在高度优先的环境中改进高危移动的男子预防和护理级联的方法。

Project Summary Ending the AIDS epidemic in sub-Saharan will require further engagement of men in HIV testing, prevention, and treatment, a challenging task given that nearly 50% of HIV-positive men in many countries are unaware of their HIV status and men have lower uptake of HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). This study focuses on a highly mobile population of men – fishermen – in Kenya’s Lake Victoria shoreline communities, where HIV incidence rates are extremely high. Two recent innovations – HIV self- testing (HIVST) and social network-based interventions – hold promise for overcoming barriers to HIV testing and linkage to services for both HIV-positive and HIV-negative men. This study seeks to determine if an HIV status-neutral, social network-based approach, along with low-cost incentives, can promote HIV testing, linkage to care and prevention, and better health outcomes in men. It will pursue three aims: Aim 1: Determine whether providing HIV self-tests to network-central men for distribution to other men in their close social networks increases men’s HIV testing uptake. We will conduct social network mapping in study communities in Siaya Country, Kenya to identify distinct close social networks of men. We will then randomize these social networks to intervention and control groups. Network-central, highly- connected men in each network will be recruited as “promoters”, and receive HIVST training. Promoters in networks assigned to the intervention will then receive self-tests for distribution to men in their networks. Promoters in networks assigned to the control will instead distribute vouchers for free self-tests at nearby health clinics. We hypothesize higher HIV testing among men in networks that receive the intervention. Aim 2: Determine whether network-central promoters and small incentives can increase ART and PrEP uptake among men. We will test whether network-central promoters can enhance linkage to ART and PrEP after self-testing, thereby addressing a key limitation of HIVST. Promoters in the Aim 1 intervention group will be asked to distribute information and transport vouchers for ART or PrEP to men in their networks. Our primary hypothesis is that the intervention will result in higher rates of linkage to ART or PrEP (confirmatory testing and ART referral for positives, and PrEP screening for negatives). We also hypothesize higher ART and PrEP uptake within 3 months among men in social networks assigned to the intervention group. Aim 3: Test the impact of interventions on ART or PrEP retention and adherence. We will measure 6- and 12-month VL and tenofovir levels, using a recently-developed low-cost, point-of-care PrEP adherence urine immunoassay. Across all aims, we will use qualitative and mixed methods to identify the pathways of intervention action, and understand how social networks and incentives affect testing and ART and PrEP uptake and retention. This study promises high scientific and public health impact, by testing new approaches to improve the prevention and care cascades in high-risk, mobile men in high priority settings.