Reaching the hardest of the hard-to-reach

到达最难到达的地方

• 批准号: 10765890
• 负责人: Sunil Suhas Solomon
• 金额: $ 39.67万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10765890
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Awareness; Caring; Cities; Cluster randomized trial; Communities; Continuity of Patient Care; Counseling; Epidemic; Geography; Goals; HIV; HIV/HCV; Hepatitis C; Hepatitis C virus; Human immunodeficiency virus test; Individual; Injecting drug user; Knowledge; Link; Low income; Network-based; Persons; Population; Probability; RNA; Respondent; Sampling; Testing; Time; Viral; Vision; antiretroviral therapy; cost; cost effective intervention; cost effectiveness; cost-effectiveness evaluation; improved; interest; low and middle-income countries; prevention service; primary endpoint; public health relevance; retention rate; secondary outcome

 DESCRIPTION (provided by applicant): UNAIDS has set an ambitious target of 90-90-90 by 2020 to help end the AIDS epidemic wherein 90% of all HIV-infected people will know their status, 90% of those aware of their status will receive combination antiretroviral therapy (cART) and 90% of those on therapy will achieve virologic suppression. However, for this vision to be realized, 90-90-90 needs to be achieved in all populations especially those that are hardest to reach such as people who inject drugs (PWID) in low- and middle-income countries (LMICs). PWID in LMICs account for some of the fastest growing HIV epidemics that can be attributed to at least two factors: (1) inadequate access to HIV prevention services including HIV counseling and testing (HCT); and consequently, (2) low levels of linkage to care, initiation of ART and viral suppression. While viral suppression is the ultimate goal, there are several steps that lead to viral suppression - the first two steps and probably the most challenging steps are identifying infected PWID who are unaware of their status and linking them to care. There are several strategies focused on improving rates of retention in care and viral suppression being evaluated, but there are few trials underway to identify unaware and out-of-care individuals and link them to care particularly among PWID in LMICs. Beyond HIV, PWID also bear a disproportionately high burden of HCV infection with poor levels of knowledge and a care continuum far worse than what has been observed for HIV. Accordingly, this application is focused on developing and evaluating the cost-effectiveness of two strategies to identify PWID who are HIV-infected and not engaged in care in the community and link them to care centers. Strategy 1, time-based respondent-driven sampling (tRDS), focuses exclusively on network connections to identify infected individuals in the community, provide HIV/HCV testing and link infected persons to care centers. Strategy 2, respondent-driven sampling plus targeted field-based HIV testing (RDS+), utilizes a combination of network connections and spatially targeted field-based testing to identify infected individuals and link them to care. These two strategies will be evaluated using a cluster randomized trial approach across six Indian cities at varying stages of the HIV/PWID epidemic (e.g., historical vs. emerging) and differing geographic sizes (small cites vs. large cities). The primary endpoint of interest that will be compared across the two strategies will be the cost per HIV viremic (HIV RNA>1000 copies/ml) individual linked to care. Secondary outcomes include the cost per HIV-infected (previously unaware of status) individual identified and the cost per HCV-infected (previously unaware of status) individual identified. An additional objective of this application is to fine-tune these two strategies to maximize the cost-effectiveness of each approach. These interventions if cost-effective could be replicated in other high-, middle- and low-income settings to identify out-of-care HIV/HCV infected PWID in the community and link them to care.

 描述(由申请者提供)：联合国艾滋病规划署制定了一个雄心勃勃的目标，到2020年，90-90-90帮助结束艾滋病流行，其中90%的艾滋病毒感染者将知道自己的状况，90%的知道自己状况的人将接受联合抗逆转录病毒治疗(CART)，90%的正在接受治疗的人将实现病毒抑制。然而，为了实现这一愿景，需要在所有人口中实现90-90-90，特别是那些最难接触到的人群，如低收入和中等收入国家的注射吸毒者(PWID)。LMIC中的PWID是一些增长最快的艾滋病毒流行的原因，这至少可归因于两个因素：(1)没有足够的机会获得艾滋病毒预防服务，包括艾滋病毒咨询和检测(HCT)；因此，(2)与护理、启动抗逆转录病毒治疗和病毒的联系程度较低 压制。虽然抑制病毒是最终目标，但有几个步骤可以导致病毒抑制-前两个步骤，也可能是最具挑战性的步骤是识别不知道自己状况的受感染PWID患者，并将他们与护理联系起来。有几种战略侧重于提高护理保留率和病毒抑制正在评估中，但很少有试验正在进行，以识别不知情和脱离护理的个人，并将他们与护理联系起来，特别是在LMIC中的PWID中。除了艾滋病毒，PWID还承受着不成比例的高丙型肝炎病毒感染负担，其知识水平和连续护理远远比观察到的艾滋病毒差得多。因此，这项应用的重点是开发和评估两种战略的成本效益，以确定哪些是艾滋病毒感染者和没有在社区从事护理工作的PWID，并将他们与护理中心联系起来。战略1是基于时间的受访者驱动抽样(TRDS)，专门侧重于网络连接，以识别社区中的感染者，提供艾滋病毒/丙型肝炎病毒检测，并将感染者与护理中心联系起来。战略2，受访者驱动的抽样加上有针对性的实地艾滋病毒检测(RDS+)，利用网络连接和空间定向实地检测相结合的方式来确定感染者，并将他们与护理联系起来。这两个策略将使用 在HIV/PWID流行的不同阶段(例如，历史与新兴)和不同地理规模(小城市与大城市)的六个印度城市中，采用整群随机试验方法。比较这两种策略的主要目标将是与护理有关的每个HIV病毒(HIV RNA和GT；1000拷贝/毫升)个体的成本。次要结果包括确定的每个艾滋病毒感染者(以前不知道状态)的费用和确定的每个丙型肝炎病毒感染者(以前不知道状态)的费用。此应用程序的另一个目标是微调这两种策略，以最大限度地提高每种方法的成本效益。这些干预措施如果具有成本效益，可以在其他高收入、中等收入和低收入环境中复制，以确定社区中感染艾滋病毒/丙型肝炎的非护理人员，并将其与护理联系起来。

项目成果

Improvements in Severe Acute Respiratory Syndrome Coronavirus 2 Testing Cascade in the United States: Data From Serial Cross-sectional Assessments.

• DOI: 10.1093/cid/ciab683
• 发表时间: 2022-05-03
• 期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America