HIV VCT and Linkage to Care in Uganda

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DESCRIPTION (provided by applicant): We propose to examine in a randomized controlled trial strategies for optimizing risk reduction within the context of routine HIV VCT (rVCT) and fully integrating inpatient counseling and testing with post-discharge HIV medical care to ensure that diagnosed individuals receive access to care (including antiretroviral therapy if indicated). We will use a 2 x 2 factorial design to assess the effects of (a) two modes of HIV VCT and (b) two strategies for linkage to care. This highly efficient design is an economical strategy of testing multiple interventions in a single study, and our pilot studies demonstrate that we can meet enrollment targets required by this design within the allocated time period. The first intervention will compare, in a non-inferiority study design, in-patient routine counseling and testing (rVCT) with traditional HIV pre- and post-test counseling and testing (tVCT). The second intervention will compare, in a superiority design, an "enhanced linkage to care" model for seropositive persons to increase uptake and long-term utilization of HIV-specific medical care, compared to usual referral. The primary specific aims of the study are to: Specific Aim 1 (rVCT vs tVCT): Test the hypothesis (non-inferiority hypothesis) that routine counseling and testing for HIV among hospitalized adults is as efficacious as traditional counseling and testing in reducing HIV risk behavior among inpatients after discharge. Specific Aim 2 (Enhanced Linkage vs. Usual Referral): Test the hypothesis (superiority hypothesis) that an "enhanced linkage to care" model of post-disclosure referral to HIV-specific medical care is more effective than usual referral in receipt of Ol prophylaxis, ART, and reducing mortality.