Designing an Intervention to Increase Men's Linkage to Care and Prevention after HIV Self-Testing in Uganda

项目摘要/摘要 撒哈拉以南非洲(SSA)艾滋病毒治疗和预防的成功受到#年性别差距的阻碍。 获得护理的途径。SSA中的男性接受艾滋病毒检测的可能性较小，更有可能开始抗逆转录病毒治疗 (ART)与女性相比，处于疾病晚期，导致较差的临床结果。HIV自我检测 HIVST被证明是一种创新和增强能力的方法，可以增加男性艾滋病毒检测的覆盖率。在……里面 特别是，将艾滋病毒自检从女性伴侣二次分发给男性，在#年实现了较高的接受率。 男人。然而，男性与HIVST后护理的联系并没有得到很好的评估。因为临床联系是实现 接触救生艺术和预防，包括暴露前预防(PrEP)和自愿医疗男性 包皮环切术(VMMC)，HIVST干预措施在减轻艾滋病毒负担方面的成功取决于他们是否有能力将 需要关爱的个人。这一K01奖项的目标是拓宽候选人的专业知识，使其能够独立进行 全球艾滋病毒预防研究，重点是优化艾滋病毒/艾滋病和联动战略。要完成这项工作 研究，候选人将在1)定性研究和行为科学方面发展新的能力，2) 行为经济学，以及3)实施科学。这些技能很好地建立在应聘者目前的基础上 精通流行病学、数学建模和成本效益分析。这是新开发的 技能集将使应聘者能够设计、评估和调整与当地相关的可扩展的艾滋病毒干预措施 以减轻SSA中的艾滋病毒负担。候选人已经组建了一个强大的、多学科的指导团队来指导 她的研究和职业发展。这项研究将在乌干达坎帕拉进行，在预防范围内 母婴传播(母婴传播)诊所。这是评估以下项目有效性的理想环境 二次分发艾滋病毒自检。孕妇通常报告说不知道她们的艾滋病毒状况 男性伴侣。此外，对艾滋病毒阳性妇女的伴侣进行检测是识别艾滋病毒阳性者的一种高产出战略。 需要抗逆转录病毒治疗的男性以及艾滋病毒阴性的男性血清不协调的伴侣关系可以从PrEP和 VMMC。将与男性进行面谈，了解他们的障碍和联系的动机以及 提供者/利益相关者关于将潜在干预措施整合到临床实践中的可行性(目标 1)。使用目标1中确定的干预特征，候选人将创建和管理一个离散的 对有艾滋病毒阳性女性伴侣的男性进行选择实验(目标2)。DCE引出以下特征 男性首选的HIVST干预，将被用来开发一种量身定制的干预措施，以实现最佳摄取。 最后，候选人将对50名孕妇进行最佳艾滋病毒自我检测干预的试点测试 防止母婴传播及其男性伴侣。她将评估干预措施的可接受性和联系的有效性 对男子进行确认艾滋病毒检测、治疗和预防(目标3)。这项研究是第一次评估一个 在艾滋病毒自我检测后鼓励男性联系护理的干预措施。它有可能确定战略，以 增加艾滋病毒检测和与SSA护理的联系。

PROJECT SUMMARY/ABSTRACT The success of HIV treatment and prevention in sub-Saharan Africa (SSA) is hindered by the gender disparity in access to care. Men in SSA are less likely to undergo HIV testing and more likely to start antiretroviral treatment (ART) at advanced disease stages compared to women, resulting in poorer clinical outcomes. HIV self-testing (HIVST) is shown to be an innovating and empowering method to increase HIV testing coverage in men. In particular, secondary distribution of HIV self-tests to men from their female partners has achieved high uptake in men. However, men’s linkage to care after HIVST is not well evaluated. As clinic linkage is a crucial step to accessing lifesaving ART and prevention including pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC), the success of HIVST interventions in reducing HIV burden hinges on their ability to link individuals to care. The goal of this K01 Award is to broaden the candidate’s expertise to conduct independent research in global HIV prevention, with a focus on optimizing HIVST and linkage strategies. To complete this research, the candidate will develop new competencies in 1) qualitative research and behavioral science, 2) behavioral economics, and 3) implementation science. These skills build nicely on the candidate’s current proficiencies in epidemiology, mathematical modeling, and cost-effectiveness analyses. This newly developed skillset will enable the candidate to design, evaluate, and adapt locally relevant and scalable HIV interventions to reduce HIV burden in SSA. The candidate has assembled a robust, multidisciplinary mentorship team to guide her research and career development. The research will be conducted in Kampala, Uganda, within a Prevention of Mother to Child Transmission (PMTCT) clinic. This is an ideal setting in which to evaluate the effectiveness of secondary distribution of HIV self-tests. Pregnant women commonly report not knowing the HIV-status of their male partner. Furthermore, testing partners of HIV-positive women is a high yield strategy to identify HIV-positive men in need of ART as well as HIV-negative men serodiscordant partnerships who can benefit from PrEP and VMMC. Interviews will be conducted with men regarding their barriers and motivators for linkage and with providers/stakeholders regarding the feasibility of integrating the potential interventions into clinic practice (Aim 1). Using the intervention characteristics identified in Aim 1, the candidate will create and administer a Discrete Choice Experiment (DCE) to men with HIV-positive female partners (Aim 2). The DCE elicit characteristics of men’s preferred HIVST intervention, which will be used to develop a tailored intervention for optimal uptake. Finally, the candidate will pilot-test the optimal HIV-self testing intervention to 50 pregnant women starting PMTCT and their male partners. She will evaluate the intervention’s acceptability and effectiveness in linking men to confirmatory HIV testing, treatment and prevention (Aim 3). This research is the first to evaluate an intervention to motivate male linkage to care after HIV self-testing. It has the potential to identify strategies to increase HIV testing and linkage to care in SSA.