IMPLEMENTING ASSISTED PARTNER SERVICES TO HIV TEST AND TREAT MEN IN WESTERN KENYA

为肯尼亚西部的男性实施艾滋病毒检测和治疗的辅助合作伙伴服务

• 批准号: 9797235
• 负责人: CAREY FARQUHAR
• 金额: $ 12.04万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-23 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9797235
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adopted; Adult; Advocate; Africa South of the Sahara; African; Antihypertensive Agents; Attention; Award; Caring; Chronic; Clinical Research; Counseling; Country; County; Couples; Development Plans; Diagnosis; Doctor of Philosophy; Effectiveness; Effectiveness of Interventions; Elements; Ensure; Epidemic; Europe; Female; Female Adolescents; Funding; Goals; Government; Grant; Guidelines; HIV; HIV Infections; HIV-infected adolescents; Health; Health care facility; Health system; Human immunodeficiency virus test; Hypertension; Individual; Institution; Intervention; Kenya; Knowledge; Life; Link; Measures; Medical; Methods; Nongovernmental Organizations; Observational Study; Outcome; Outcome Measure; Parents; Persons; Pharmaceutical Preparations; Physicians; Plasma; Policy Maker; Population; Positioning Attribute; Prevalence; Principal Investigator; Public Health; RNA; Randomized Clinical Trials; Recommendation; Reporting; Research; Research Personnel; Resources; Service delivery model; Services; Sexual Partners; Site; System; Testing; Training; Universities; Viral; Washington; Woman; Work; World Health Organization; base; blood pressure regulation; care systems; career development; case finding; cost; cost effectiveness; experience; girls; health difference; high risk; implementation science; improved; improved outcome; indexing; male; male health; meetings; member; men; multidisciplinary; novel; prevent; programs; recruit; research and development; routine care; scale up; screening; screening program; service intervention; success; testing services; transmission process; treatment adherence; treatment guidelines; treatment program; treatment services; uptake; young woman

Specific Aims Increasing the proportion of people living with HIV who know their serostatus is critical to containing the HIV epidemic in sub-Saharan Africa. In Kenya, approximately 1.6 million people are living with HIV and it is estimated that 53% of HIV-infected Kenyans are unaware of their status1. Although numbers of adults tested for HIV increased more than 6-fold between 2008 and 2010 in Kenya, testing rates have been stable since 2010 and significant gaps in testing are being identified. While it is not surprising that members of key populations are often not reached with standard testing strategies, it is surprising that 25-50 year old men are significantly less likely to test and link to care if infected. This proposal will focus on this latter demographic. In 2014 only 45% of men reported that they had tested in the last year compared to more than 53% of women 2, and it is essential that new testing strategies that narrow existing gaps be adopted if Kenya is to reach the first “90” in the UNAIDS 90-90-90 by 20203. Specifically, if Kenya is to move from about half of persons living with HIV (PLWH) knowing their status to 90%, greater progress needs to be made in HIV testing men and linking them to care. While there will be additional challenges once linked to care, the first step in the cascade is critically important, a step upon which all others are dependent for success. Last year we successfully completed a cluster randomized clinical trial (RCT) of assisted partner services (aPS) to promote testing of individuals at high risk for HIV infection, many of whom were unaware of their status and had not previously tested.4-6 The aPS intervention involves notifying sexual partners of individuals diagnosed with HIV and offering testing and linkage to care. As a public health strategy to prevent the transmission of HIV through testing and treating the sexual partners of infected index cases, aPS is widely adopted in the US and Europe but has not been scaled up in sub-Saharan Africa. Our trial took place in central and western Kenya where we employed and trained study staff to deliver aPS in 18 different facilities, and determined that aPS is safe and highly effective for HIV case finding and linkage to care under these conditions.4,5 Despite this trial showing efficacy and the World Health Organization releasing guidelines in November 2016 promoting partner services7, rolling out aPS at scale will be challenging. Effectiveness of an intervention when integrated into existing health systems is usually lower than the efficacy determined in controlled trials due to weaknesses in health systems and differences in intervention delivery. Implementation science advocates for more real life research that utilizes existing systems to deliver interventions at scale and this is what this project aims to do. We propose to study the effectiveness and feasibility of aPS in Homa Bay and Kisumu, two Kenyan counties with the highest HIV prevalence in the country, and generate evidence that will ensure rapid and sustainable implementation across the region. We will accomplish these objectives through the following Specific Aims: AIM 1. Evaluate effectiveness of assisted partner services (aPS) when integrated within an existing Kenya Ministry of Health (MOH) health initiative, APHIAplus, to strengthen HIV services in western Kenya by determining that aPS improves HIV testing rates among men, identifies new HIV infections among men, and links these men to HIV care and treatment, as measured by viral suppression 12 months after diagnosis. Leveraging the completed RCT, we are in a unique position to assess the following outcomes: 1)HIV testing among men who have never tested 2) New male HIV infections and HIV-discordant couples 3) Linkage to care by 6 weeks and initiation of ART by 6 months for HIV-infected men identified by aPS 4) Suppression of plasma HIV RNA levels at 12 months among these HIV-infected men AIM 2. Determine fidelity, feasibility, cost and cost-effectiveness of implementing integrated aPS services among HIV-infected adolescent girls and women through existing HIV services. We will generate evidence to inform effective scale-up and sustainability of aPS, focusing on the resources and capacity of the Kenyan government and local institutions to adapt this testing strategy to new populations and cost constraints. Specifically, we will evaluate the following: 1) Implementation elements associated with high uptake of HIV testing, linkage to care and treatment 2) Health facility and individual-level factors that influence fidelity to the aPS intervention 3) Acceptability, demand, and health system requirements influencing feasibility 4) Impact on health outcomes during and after integration of aPS into existing HIV testing services 5) Costs and cost-effectiveness of aPS when integrated into existing HIV testing services Impact: The Kenya Ministry of Health and National AIDS and STI Control Program (NASCOP) have identified assisted partner services as a key strategy for achieving national 90-90-90 goals and recently held a meeting affirming their commitment to scaling up aPS within HIV testing programs. The proposed project will bridge the gap between clinical research findings, everyday practice and public health, and provide much-needed guidance on how to integrate this strategy while retaining its efficacy and ensuring sustainability.

具体目标 增加了解自己血清状况的艾滋病毒感染者比例对于遏制艾滋病毒至关重要 撒哈拉以南非洲地区的流行病。在肯尼亚，大约有 160 万人感染艾滋病毒，据估计 53% 的艾滋病毒感染者肯尼亚人不知道自己的状况1。尽管许多成年人接受了艾滋病毒检测 2008 年至 2010 年间，肯尼亚的检测率增加了 6 倍多，自 2010 年以来检测率一直稳定， 正在确定测试中的重大差距。虽然关键人群的成员是不足为奇的 使用标准测试策略通常无法达到这一目标，但令人惊讶的是 25-50 岁的男性明显低于 如果感染，可能会进行测试并联系护理人员。该提案将重点关注后者。 2014 年仅 45% 男性报告说，他们在去年进行了检测，而女性的这一比例超过 53% 2，这是至关重要的 如果肯尼亚要达到联合国艾滋病规划署的第一个“90”，就必须采取新的检测策略来缩小现有差距 到 20203 年，这一数字将达到 90-90-90。具体而言，如果肯尼亚要从大约一半的艾滋病毒感染者 (PLWH) 迁出 如果男性的艾滋病毒感染率达到 90%，则需要在男性艾滋病毒检测和将他们与护理联系起来方面取得更大进展。在那里 一旦与护理联系起来，将是额外的挑战，级联中的第一步至关重要，是后续的一步 所有其他人的成功都依赖于此。 去年，我们成功完成了辅助合作伙伴服务的整群随机临床试验（RCT） (aPS) 旨在促进对艾滋病毒感染高危人群进行检测，其中许多人不知道自己的情况 状态且之前未进行过测试。4-6 aPS 干预包括通知个人的性伴侣 被诊断患有艾滋病毒并提供检测和护理联系。作为一项公共卫生战略，旨在预防 通过检测和治疗感染指标病例的性伴侣来传播艾滋病毒，aPS 已被广泛 美国和欧洲采用，但尚未在撒哈拉以南非洲推广。我们的审判在中环进行 在肯尼亚西部，我们雇用并培训了研究人员，在 18 个不同的设施中提供 aPS，以及 确定 aPS 对于艾滋病毒病例发现以及与这些护理的联系是安全且高度有效的 4,5 尽管这项试验显示出有效性并且世界卫生组织发布了指南 2016 年 11 月推广合作伙伴服务7，大规模推出 aPS 将具有挑战性。的有效性 纳入现有卫生系统后的干预通常低于在 由于卫生系统的弱点和干预措施的差异，进行了对照试验。执行 科学倡导更多的现实生活研究，利用现有系统大规模提供干预措施 这就是这个项目的目的。我们建议研究霍马湾aPS的有效性和可行性 和基苏木，肯尼亚艾滋病毒感染率最高的两个县，并提供证据表明 将确保在整个地区快速、可持续地实施。我们将实现这些目标 通过以下具体目标： 目标 1. 评估辅助合作伙伴服务 (aPS) 整合到现有肯尼亚境内时的有效性 卫生部 (MOH) 卫生倡议 APHIAplus 旨在通过以下方式加强肯尼亚西部的艾滋病毒服务： 确定 aPS 提高了男性中的 HIV 检测率，识别了男性中新的 HIV 感染，以及 将这些男性与艾滋病毒护理和治疗联系起来，通过诊断后 12 个月的病毒抑制来衡量。 利用已完成的随机对照试验，我们处于独特的地位来评估以下结果： 1）对从未检测过的男性进行艾滋病毒检测 2) 新的男性艾滋病毒感染者和艾滋病毒不一致的夫妇 3) 对于 aPS 确定的 HIV 感染男性，在 6 周内进行护理并在 6 个月内开始 ART 4) 12 个月时这些 HIV 感染男性血浆 HIV RNA 水平受到抑制 目标 2. 确定实施集成 aPS 服务的保真度、可行性、成本和成本效益 通过现有的艾滋病毒服务，帮助感染艾滋病毒的少女和妇女。我们将生成证据 为 aPS 的有效扩大和可持续性提供信息，重点关注肯尼亚的资源和能力 政府和地方机构使这一测试策略适应新的人群和成本限制。 具体来说，我们将评估以下内容： 1) 与艾滋病毒检测的高采用率、与护理和治疗的联系相关的实施要素 2) 影响 aPS 干预忠诚度的医疗机构和个人层面的因素 3) 影响可行性的可接受性、需求和卫生系统要求 4) aPS 纳入现有 HIV 检测服务期间和之后对健康结果的影响 5) aPS 融入现有 HIV 检测服务时的成本和成本效益 影响：肯尼亚卫生部和国家艾滋病和性传播感染控制计划 (NASCOP) 已确定 协助合作伙伴服务作为实现国家90-90-90目标的关键战略，并于最近召开了一次会议 确认他们在艾滋病毒检测项目中扩大 aPS 的承诺。拟议的项目将架起桥梁 临床研究结果、日常实践和公共卫生之间的差距，并提供急需的指导 讨论如何整合这一战略，同时保持其有效性并确保可持续性。