Self-Test Strategies and Linkage Incentives to Improve ART and PrEP Uptake in Men

提高男性 ART 和 PrEP 采用率的自测策略和关联激励措施

• 批准号: 10632006
• 负责人: Carol Suzanne Camlin
• 金额: $ 58.78万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10632006
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Africa South of the Sahara; Behavior; Behavior Therapy; Biological Assay; Caring; Clinic; Cluster randomized trial; Communities; Control Groups; Country; Epidemic; Fishes; Foundations; Gender; HIV; HIV Seronegativity; HIV Seropositivity; HIV antiretroviral; HIV risk; Health; Health Services Accessibility; Human immunodeficiency virus test; Immunoassay; Incentives; Incidence; Intervention; Kenya; Maps; Measures; Methods; Network-based; Outcome; Outcome Assessment; Participant; Pathway interactions; Policies; Population; Positioning Attribute; Prevalence; Prevention; Price; Privacy; Public Health; Randomized; Recommendation; Research; Risk; Services; Social Network; Tenofovir; Testing; Training; Transact; Urine; Woman; Work; antiretroviral therapy; behavior influence; behavioral economics; cost; financial incentive; group intervention; high risk; improved; innovation; insight; men; new technology; novel strategies; peer influence; point of care; point of care testing; pre-exposure prophylaxis; prevention service; promoter; recruit; referral services; scale up; screening; self testing; sex; social stigma; testing uptake; transmission process; treatment services; uptake; voucher

Project Summary Ending the AIDS epidemic in sub-Saharan will require further engagement of men in HIV testing, prevention, and treatment, a challenging task given that nearly 50% of HIV-positive men in many countries are unaware of their HIV status and men have lower uptake of HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). This study focuses on a highly mobile population of men – fishermen – in Kenya’s Lake Victoria shoreline communities, where HIV incidence rates are extremely high. Two recent innovations – HIV self- testing (HIVST) and social network-based interventions – hold promise for overcoming barriers to HIV testing and linkage to services for both HIV-positive and HIV-negative men. This study seeks to determine if an HIV status-neutral, social network-based approach, along with low-cost incentives, can promote HIV testing, linkage to care and prevention, and better health outcomes in men. It will pursue three aims: Aim 1: Determine whether providing HIV self-tests to network-central men for distribution to other men in their close social networks increases men’s HIV testing uptake. We will conduct social network mapping in study communities in Siaya Country, Kenya to identify distinct close social networks of men. We will then randomize these social networks to intervention and control groups. Network-central, highly- connected men in each network will be recruited as “promoters”, and receive HIVST training. Promoters in networks assigned to the intervention will then receive self-tests for distribution to men in their networks. Promoters in networks assigned to the control will instead distribute vouchers for free self-tests at nearby health clinics. We hypothesize higher HIV testing among men in networks that receive the intervention. Aim 2: Determine whether network-central promoters and small incentives can increase ART and PrEP uptake among men. We will test whether network-central promoters can enhance linkage to ART and PrEP after self-testing, thereby addressing a key limitation of HIVST. Promoters in the Aim 1 intervention group will be asked to distribute information and transport vouchers for ART or PrEP to men in their networks. Our primary hypothesis is that the intervention will result in higher rates of linkage to ART or PrEP (confirmatory testing and ART referral for positives, and PrEP screening for negatives). We also hypothesize higher ART and PrEP uptake within 3 months among men in social networks assigned to the intervention group. Aim 3: Test the impact of interventions on ART or PrEP retention and adherence. We will measure 6- and 12-month VL and tenofovir levels, using a recently-developed low-cost, point-of-care PrEP adherence urine immunoassay. Across all aims, we will use qualitative and mixed methods to identify the pathways of intervention action, and understand how social networks and incentives affect testing and ART and PrEP uptake and retention. This study promises high scientific and public health impact, by testing new approaches to improve the prevention and care cascades in high-risk, mobile men in high priority settings.

项目概要 结束撒哈拉以南地区的艾滋病流行需要男性进一步参与艾滋病毒检测、预防、 鉴于许多国家近 50% 的艾滋病毒阳性男性不知道这一点，这是一项艰巨的任务 他们的艾滋病毒状况和男性对艾滋病毒抗逆转录病毒治疗（ART）和暴露前预防的接受率较低 （PrEP）。这项研究的重点是肯尼亚维多利亚湖中流动性较高的男性群体——渔民 艾滋病毒发病率极高的海岸线社区。最近的两项创新——艾滋病毒自我 检测（HIVST）和基于社交网络的干预措施——有望克服艾滋病毒检测的障碍 以及为艾滋病毒阳性和艾滋病毒阴性男性提供的服务的联系。本研究旨在确定艾滋病毒是否 地位中立、基于社交网络的方法以及低成本激励措施可以促进艾滋病毒检测， 与护理和预防以及改善男性健康结果的联系。它将追求三个目标： 目标 1：确定是否向网络中心男性提供艾滋病毒自我检测，并分发给其他男性 在他们密切的社交网络中增加了男性艾滋病毒检测的接受率。我们将开展社交网络 在肯尼亚西亚亚县的研究社区中绘制地图，以确定男性独特的紧密社交网络。 然后，我们将这些社交网络随机分为干预组和对照组。以网络为中心、高度 每个网络中的相关人员将被招募为“推动者”，并接受艾滋病毒和艾滋病防治培训。促销员在 然后，分配给干预措施的网络将收到自我测试，并分发给其网络中的男性。 分配给控制组的网络中的促销员将改为在附近分发用于免费自检的优惠券 健康诊所。我们假设接受干预的网络中男性的艾滋病毒检测率更高。 目标 2：确定网络中心发起者和小额激励措施是否可以增加 ART 和 PrEP 男性之间的吸收。我们将测试网络中心启动子是否可以增强与 ART 和 PrEP 的联系 经过自我测试，从而解决了 HIVST 的一个关键限制。 Aim 1 干预组的发起人 将被要求向其网络中的男性分发 ART 或 PrEP 的信息和交通券。我们的 主要假设是干预措施将导致与 ART 或 PrEP 的关联率更高（证实 阳性的检测和 ART 转诊，阴性的 PrEP 筛查）。我们还假设更高的 ART 分配到干预组的社交网络中的男性在 3 个月内对 PrEP 的采用情况。 目标 3：测试干预措施对 ART 或 PrEP 保留和依从性的影响。我们将测量 6- 以及 12 个月的 VL 和替诺福韦水平，使用最近开发的低成本、护理点 PrEP 依从性 尿液免疫测定。在所有目标中，我们将使用定性和混合方法来确定路径 干预行动，并了解社交网络和激励措施如何影响检测以及 ART 和 PrEP 吸收和保留。这项研究通过测试新的方法有望对科学和公共卫生产生重大影响 改善高危、流动男性在高度优先环境中的预防和护理级联的方法。