Reaching the last 20%: a targeted HIV self-test secondary distribution intervention to engage high-risk men in Kenya

达到%20the%20last%2020%：%20a%20针对性%20HIV%20自检%20次要%20分布%20干预%20至%20参与%20高风险%20男性%20in%20肯尼亚

• 批准号: 10636880
• 负责人: Sue Napierala
• 金额: $ 62.89万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-06 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10636880
• 关键词: AIDS prevention; Address; Africa South of the Sahara; Caring; Clinic; Cluster randomized trial; Computerized Medical Record; Cost Effectiveness Analysis; Counseling; Couples; Data; Diagnosis; Diagnostic Reagent Kits; Effectiveness of Interventions; Enrollment; Epidemic; Face; Female; Geography; Goals; HIV; HIV Infections; Health; High Risk Woman; Hot Spot; Hour; Human immunodeficiency virus test; Individual; Intervention; Interview; Kenya; Liquid substance; Location; Measures; Modeling; Oral; Pathway interactions; Pattern; Persons; Pilot Projects; Population; Population Sizes; Positioning Attribute; Prevalence; Prevention; Qualitative Research; Questionnaires; Randomized; Reporting; Research; Research Personnel; Services; Sexual Partners; Testing; Transact; Woman; contextual factors; cost; cost effective; cost effectiveness; effectiveness evaluation; experience; follow-up; high risk; high risk men; high risk population; incremental cost-effectiveness; indexing; innovation; male; men; patient population; pilot test; pre-exposure prophylaxis; primary outcome; process evaluation; programs; randomized trial; recruit; secondary outcome; self testing; service delivery; sex; standard of care; testing services; tool; transmission process; trial design; uptake

PROJECT SUMMARY Limited use of HIV services by those at highest risk is one of the primary reasons for continued HIV transmission in sub-Saharan Africa. Identifying and engaging these individuals—particularly the 20% of people living with HIV who are unaware of their status—is a major challenge that is not being met by existing service delivery approaches. Men who purchase sex (MPS) are of particularly high priority because they are twice as likely to be HIV-infected as other men and are inherently challenging to identify and reach with HIV services. The proposed project will take place in the region of Kenya with the highest HIV prevalence and seeks to promote engagement in HIV testing, prevention, and care by MPS. Preliminary data demonstrate that “secondary distribution” of HIV self-tests by women who sell sex (WSS) to their sexual partners is acceptable, feasible, and safe and leads to high male partner testing. However, the use of post–self-test services has seldom been promoted or measured in a secondary distribution model. Our interdisciplinary and experienced team of Investigators will address this key gap. Led by an Early Stage Investigator, this project will use a pair-matched cluster-randomized trial design to test an innovative, well-targeted HIV self-test secondary distribution intervention to promote uptake of HIV services by MPS. Clusters served by Ministry of Health–supported HIV clinics will be randomized to receive the secondary distribution intervention or standard of care. In intervention clusters, we will recruit WSS from key population clinics and transactional sex “hot spots.” WSS will be provided with oral fluid–based HIV self-tests and encouraged to distribute them to their male transactional sex partners. Self-test kits will include salient information for men on clinic location and hours within their cluster, and pilot-tested messaging on the importance of early ART initiation, and the availability and benefits of PrEP. In Aim 1, we will evaluate programmatic data from HIV clinics in study clusters to objectively determine the intervention’s impact on uptake of confirmatory testing, ART initiation, and PrEP initiation by men. In Aim 2, we will conduct a process evaluation to characterize factors influencing intervention effectiveness. We will assess secondary distribution patterns and characterize the MPS population receiving self-tests through quantitative program data and a follow-up questionnaire among enrolled WSS. We will use qualitative data obtained through in-depth interviews with MPS to explore pathways and contextual factors influencing whether they accessed post-test services. In Aim 3, we will compute the incremental cost-effectiveness of our intervention to inform decisions about broader implementation. This project has the potential to break new ground on ways to engage high-risk and hard-to- reach populations in HIV services. If effective, our approach could be readily adapted to other settings and help advance global goals for HIV elimination.

项目总结 高危人群对艾滋病毒服务的使用有限是艾滋病毒持续存在的主要原因之一 在撒哈拉以南非洲的传播。识别并吸引这些人--特别是20%的人 艾滋病毒携带者，他们不知道自己的状态--这是现有服务无法应对的重大挑战 快要送货了。购买性服务(MPS)的男性尤其优先，因为他们是男性的两倍 可能像其他男性一样感染艾滋病毒，而且在识别和接触艾滋病毒服务方面具有内在的挑战性。 拟议的项目将在艾滋病毒流行率最高的肯尼亚地区进行，并寻求 促进国会议员参与艾滋病毒检测、预防和护理。初步数据显示， 性交易妇女(WSS)向其性伴侣“二次分发”艾滋病毒自我检测是可以接受的， 可行的，安全的，并导致高男性伴侣测试。然而，后自我测试服务的使用已经 很少在二次分配模型中得到推广或衡量。我们的跨学科和经验丰富的 调查团队将解决这一关键差距。 在早期研究人员的带领下，该项目将使用配对的整群随机试验设计 测试一种创新的、有针对性的艾滋病毒自检二次分发干预措施，以促进艾滋病毒的吸收 国会议员提供的服务。由卫生部支持的艾滋病毒诊所提供服务的集群将被随机分配到 二次分配干预或护理标准。在干预集群中，我们将从KEY招募WSS 人口诊所和交易性行为的“热点”。WSS将提供基于口服液的艾滋病毒自我检测 并被鼓励将它们分发给他们的男性交易性伴侣。自检套件将包括显著的 为男性提供有关其群集中诊所位置和工作时间的信息，以及在 早期抗逆转录病毒治疗的重要性，以及PrEP的可用性和益处。在目标1中，我们将评估 来自研究集群中艾滋病毒诊所的规划数据，以客观地确定干预对 男性对验证性测试、ART启动和PrEP启动的理解。在目标2中，我们将进行一个过程 评价影响干预效果的因素。我们将评估二次分配 通过定量的计划数据和一个 对登记在册的WSS进行跟踪调查。我们将使用通过深入采访获得的定性数据 与国会议员一起探索影响他们是否获得测试后服务的途径和背景因素。在……里面 目标3，我们将计算干预措施的增量成本效益，以便为更广泛的决策提供信息 实施。该项目有可能在接触高风险和难以 通过艾滋病毒服务惠及人群。如果有效，我们的方法可以很容易地适应其他环境和帮助 推进消除艾滋病毒的全球目标。