Know Your Network: A concurrency reduction intervention

描述(由申请人提供)：该提案寻求对形成性研究的支持，以完善侧重于同时伙伴关系的艾滋病毒预防干预措施。当一个人在与之前的伴侣结束关系之前就开始与新伴侣发生性关系时，就会发生并发。十多年的研究表明，这种行为增加了人群中的流行潜力。越来越多的证据还表明，并发在解释撒哈拉以南非洲地区艾滋病毒普遍流行方面发挥了关键作用，越来越多的人达成共识，认为需要尝试减少并发干预。我们已经初步设计了一个基于“了解你的网络”(KYN)概念的社区级并发干预的随机试验。它从肯尼亚西部的研究传播活动演变而来，旨在纳入在整个撒哈拉以南非洲地区开始的以家庭为基础的咨询和测试(HCT)的推广。这项干预活动有两个组成部分，我们试图在这里进行评估：(1)一套旨在提高人们对并发的认识并促进对并发如何增加社区层面艾滋病毒传播风险的直观理解的互动练习；(2)简短的9个问题调查，让参与者提供有关性伙伴关系的时间和顺序的匿名行为数据，这些数据使用手持设备收集、集中下载并在现场转换为他们的性伙伴关系网络的模拟，并进行集体讨论。如果这一干预措施能够被证明是可行的、可接受的和质量上有效的，我们已经确定了一个地点，在那里它可以被整合到连续的三波HCT中，从而有可能确定与联合干预措施相关的艾滋病毒发病率的变化。目前的提案寻求对现阶段所需的形成性研究的支持。具体目的是：(1)通过与村长和长老、社区代表和保健工作者举行传统的东非参与性会议(Mabaraza)，以及与社区成员进行重点小组讨论，改进将作为kyn干预措施一部分的村一级活动的设计；(2)在预定的一轮母婴护理之后，立即在单个村庄进行一次全面试验，以预测kyn干预措施；以及(3)使用mabaraza方法对干预措施进行评估，并根据需要进行修改。如果成功，这种干预有很大的希望，因为它利用“群体免疫”的原则，以最小的行为减少最大限度地减少传播。 公共卫生相关性：同时发生的性关系似乎在解释撒哈拉以南非洲地区严重的普遍流行病方面发挥了重要作用。该项目开发了一种并发减少干预措施，旨在将其整合到新的以社区为导向的家庭咨询和测试项目中。这种行为干预和生物医学干预的结合提供了检测、治疗和预防的自然整合，并提供了一个独特的机会，可以对这种方法的有效性进行快速、经济的随机试验。

DESCRIPTION (provided by applicant): This proposal seeks support for formative research to refine an HIV prevention intervention that focuses on concurrent partnerships. Concurrency happens when a person begins a sexual relationship with a new partner before ending a relationship with a previous partner. Over a decade of research has shown that this behavior increases the epidemic potential in a population. Evidence also increasingly suggests that concurrency plays a key role in explaining the generalized epidemics of HIV in the sub-Saharan African region, and there is growing consensus that a trial of a concurrency reduction intervention is needed. We have a preliminary design for a randomized trial of a community-level concurrency intervention based on the concept of "Know Your Network" (KYN). It evolved from study dissemination activities in Western Kenya and is designed to be integrated into the rollout of home based counseling and testing (HCT) that is beginning throughout sub-Saharan Africa. The intervention has a two component, village-level activity that we seek to evaluate here: (1) a set of interactive exercises aimed at increasing awareness of concurrency and fostering an intuitive understanding of how concurrency increases the community level risk of HIV spread; (2) a brief 9 question survey that engages the participants in providing anonymous behavioral data on the timing and sequence of sexual partnerships, which is collected using handheld devices, centrally downloaded and transformed on site into simulations of their sexual partnership network, and discussed collectively. If this intervention can be shown to be feasible, acceptable and qualitatively effective, we have identified a site where it can be integrated into three successive waves of HCT, making it possible to identify changes in HIV incidence associated with the combined interventions. The current proposal seeks support for the formative research needed at this stage. The specific aims are to: (1) Refine the design of the village-level activities that will be used as part of the KYN intervention, using traditional East African participatory meetings (mabaraza) with village chiefs and elders, community representatives and health care workers, and focus group discussions with community members; (2) Pretest the KYN intervention with one full trial run in a single village immediately following a scheduled round of HCT; and (3) Evaluate the intervention using the mabaraza method and modify as needed. If successful, this intervention has great promise because it leverages the principle of "herd immunity" to obtain maximal reductions in transmission with minimal reductions in behavior. PUBLIC HEALTH RELEVANCE: Concurrent sexual partnerships appear to play an important role in explaining the severe generalized epidemics in the sub-Saharan African region. This project develops a concurrency reduction intervention designed to be integrated into the new community oriented programs of home-based counseling and testing. This combination of behavioral and biomedical interventions offers a natural integration of testing, treatment and prevention, and a unique opportunity to conduct a rapid, economical randomized trial of the effectiveness of this approach.