Confidential social network referrals for HIV testing (CONSORT)

HIV 检测的保密社交网络推荐 (CONSORT)

• 批准号: 10684258
• 负责人: Bernard Njau
• 金额: $ 17万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-12 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10684258
• 关键词: Address; Adherence; Adult; Algorithms; Appointment; Architecture; Area; Awareness; Caring; Cellular Phone; Characteristics; Client; Clinic; Code; Collaborations; Communication; Contact Tracing; Continuity of Patient Care; Counseling; Country; Data; Development; Diagnosis; Disclosure; Eastern Africa; Funding; Goals; HIV; HIV diagnosis; HIV/AIDS; Health Technology; Health behavior; Health system; Human immunodeficiency virus test; Incentives; Individual; Intervention; Legal; Link; Methods; Mobile Health Application; Participant; Partner Notification; Patients; Performance; Persons; Phase; Play; Population; Prevalence; Prevention; Privacy; Provider; Randomized, Controlled Trials; Research; Resource-limited setting; Risk; Role; Secure; Side; Site; Social Network; Southern Africa; Specific qualifier value; System; Tanzania; Technology; Telephone; Testing; United States National Institutes of Health; Viral; Work; antiretroviral therapy; arm; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; digital; digital health; efficacy evaluation; high risk population; improved; incremental cost-effectiveness; indexing; intervention cost; low and middle-income countries; mHealth; novel; novel strategies; open source; patient oriented; pilot test; primary outcome; secondary outcome; social; social engagement; social media; social stigma; testing uptake; tool; transmission process; treatment center; uptake

UNAIDS set for 2030 the ambitious 95-95-95 target: diagnosing 95% of all persons living with HIV (PWH), initiating antiretroviral therapy for 95% of those diagnosed, and achieving viral suppression for 95% of those treated. In Tanzania, a PEPFAR strategy country with an adult HIV prevalence of 4.8%, only 83% of PWH are aware of their status. More than 200,000 undiagnosed PWH need to test in order to reach the “first 95”. With the cost-effectiveness of traditional HIV testing approaches declining, we propose to evaluate a novel application of mobile health (mHealth) technology that leverages the ubiquity of mobile phones and the reach of social networks to increase rates of HIV testing, especially among higher-risk individuals. Specifically, we will evaluate the acceptability, efficacy, and cost-effectiveness of automated, confidential, SMS-based HIV testing referrals, as a means of ‘nudging’ individuals to test. We hypothesize that an automated, confidential referral system, developed and deployed in the Kilimanjaro Region of Tanzania, will be acceptable to both index clients and their referrals and that it will be cost-effective for increasing HIV testing rates. Building on existing relationships with all 25 HIV counseling and testing (HCT) providers in the study area, including 8 HIV care and treatment centers (CTCs), and using an open-source, low-code, and highly versatile mobile phone-based appointment reminder and incentive system (mParis), this study will address the following specific aims: R21 Phase: Aim 1 will conduct qualitative, formative work with (1) HCT providers, (2) HCT clients, (3) PWH who are in care at CTCs, and (4) social network contacts of HCT and CTC clients, to identify desirable provider- and client-side characteristics of an SMS-based HIV testing referral system. Aim 2 will adapt our mParis system to receive phone numbers of HIV testing referrals identified by index clients and autonomously send confidential HIV testing invitations. Aim 3 will pilot-test the Confidential Social Network Referrals for HIV Testing (CONSORT) system to collect preliminary data on the system’s acceptability, performance, and potential efficacy. R33 Phase: Aim 4 will evaluate the acceptability and efficacy of CONSORT in a pragmatic randomized controlled trial with 400 HCT clients and 200 HIV-infected CTC patients. Arm 1 participants will be offered confidential SMS referrals and physical invitation cards (“card referrals”) to extend to any of their network contacts. Arm 2 participants will be offered card referrals alone. The primary outcome will be uptake of HIV testing. Secondary outcomes include the number of new HIV diagnoses, and the risk correlation within referral networks. Aim 5 will evaluate the incremental cost-effectiveness of CONSORT+card referrals vs. card referrals alone. The study will provide estimates of the acceptability, efficacy, and cost-effectiveness of an exceptionally low-cost intervention for increasing the uptake of HIV testing. More broadly it will develop analytic and mHealth capacity in Tanzania and inform the development of mobile phone-based chain-referral interventions that can reach key social networks, are transferrable to other technologies, and can be extended beyond HIV testing.

联合国艾滋病规划署为 2030 年设定了雄心勃勃的 95-95-95 目标：诊断 95% 的艾滋病毒感染者 (PWH)， 95% 的确诊患者开始抗逆转录病毒治疗，并实现 95% 的病毒抑制 治疗。在坦桑尼亚这个 PEPFAR 战略国家，成人艾滋病毒感染率为 4.8%，但只有 83% 的感染者感染了艾滋病毒。 知道他们的状况。超过20万未确诊的感染者需要接受检测才能达到“第一个95”。 随着传统艾滋病毒检测方法的成本效益下降，我们建议评估一种新的方法 移动医疗（mHealth）技术的应用充分利用了移动电话的普及和覆盖范围 社交网络以提高艾滋病毒检测率，尤其是高危人群。具体来说，我们将 评估自动化、保密、基于短信的 HIV 检测的可接受性、有效性和成本效益 推荐，作为“推动”个人进行测试的一种手段。我们假设自动化的、保密的转介 在坦桑尼亚乞力马扎罗地区开发和部署的系统将为两个指数客户所接受 以及他们的转介，这对于提高艾滋病毒检测率来说具有成本效益。建立在现有的基础上 与研究区域内所有 25 个 HIV 咨询和检测 (HCT) 提供者的关系，包括 8 个 HIV 护理和 治疗中心 (CTC)，并使用开源、低代码且高度通用的基于移动电话的 预约提醒和激励系统（mParis），本研究将解决以下具体目标： R21 阶段：目标 1 将与 (1) HCT 提供者、(2) HCT 客户、(3) PWH 开展定性、形成性工作 (4) HCT 和 CTC 客户的社交网络联系人，以确定理想的提供者和 基于 SMS 的 HIV 检测转诊系统的客户端特征。目标 2 将使我们的 mParis 系统适应 接收索引客户确定的艾滋病毒检测转介电话号码并自动发送机密信息 HIV 检测邀请。目标 3 将试点艾滋病毒检测保密社交网络推荐 (CONSORT) 系统收集有关系统可接受性、性能和潜在功效的初步数据。 R33 阶段：目标 4 将在一项实用的随机试验中评估 CONSORT 的可接受性和有效性 一项针对 400 名 HCT 客户和 200 名 HIV 感染 CTC 患者的对照试验。第 1 组参与者将获得 机密短信推荐和实体邀请卡（“卡推荐”）可扩展到其任何网络 联系人。第 2 组参与者将仅获得卡推荐。主要结果将是艾滋病毒的吸收 测试。次要结果包括新的艾滋病毒诊断数量以及转诊内的风险相关性 网络。目标 5 将评估 CONSORT+ 卡推荐与卡推荐的增量成本效益 独自的。该研究将提供对特殊疗法的可接受性、功效和成本效益的估计。 提高艾滋病毒检测率的低成本干预措施。更广泛地说，它将开发分析和移动医疗 坦桑尼亚的能力，并为基于移动电话的连锁转介干预措施的发展提供信息，这些干预措施可以 覆盖关键的社交网络，可以转移到其他技术，并且可以扩展到艾滋病毒检测之外。