Harnessing male peer networks to enhance engagement with HIV prevention: A large-scale cluster randomized trial to increase HIV self-testing and PrEP uptake among men in Eastern Zimbabwe

利用男性同伴网络加强艾滋病毒预防的参与：一项旨在提高津巴布韦东部男性艾滋病毒自我检测和 PrEP 接受率的大规模整群随机试验

• 批准号: 10700233
• 负责人: Constance Nyamukapa
• 金额: $ 50万
• 依托单位: STELLENBOSCH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-03 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700233
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Affect; Africa South of the Sahara; African; Automobile Driving; Awareness; Behavioral Research; Calibration; Caring; Characteristics; Clinic; Cluster randomized trial; Communities; Data; Development; Diagnostic Reagent Kits; Epidemic; Evaluation; Face; Female Adolescents; Gender; General Population; Goals; HIV; HIV Infections; HIV Seronegativity; Health; High Prevalence; Human immunodeficiency virus test; Improve Access; Incidence; Individual; Infrastructure; Intervention; Laboratories; Logic; Mathematics; Measures; Methods; Modeling; Network-based; Outcome; Paper; Penetration; Performance; Population; Prevention; Principal Investigator; Process; Research; Risk; Risk Assessment; Rural; Seminal; Social Network; South Africa; Structure; Subgroup; Telephone; Testing; Woman; Work; Zimbabwe; behavior test; care systems; cluster randomized design; cohort; cost effectiveness; eHealth; effectiveness trial; health care availability; implementation evaluation; implementation fidelity; implementation science; improved; innovation; male; mathematical model; meetings; men; novel strategies; peer; peer networks; pre-exposure prophylaxis; prevention service; primary outcome; programs; public health research; response; risk perception; scale up; secondary outcome; self testing; study population; testing services; transmission process; treatment services; uptake; young woman

PROJECT SUMMARY Novel strategies are needed to engage men in Sub Saharan Africa (SSA) with HIV testing, treatment and prevention services to drive the epidemic towards elimination. Suboptimal engagement with HIV prevention by men increases their risk of HIV acquisition, and is an important driver of new HIV infections in women. HIV self- testing (HIVST) addresses several key facility-based access barriers and HIVST distribution through leveraging male peer networks for HIV prevention is feasible, acceptable and effective in SSA. The objective of this project is to use an implementation science approach to establish the impact of HIVST distribution through male social networks, with phone-based support and improved risk perception, on PrEP uptake among men in Eastern Zimbabwe. The project will leverage infrastructure and data associated with 20- year programme of HIV surveillance and behavioural research in a well-characterized population cohort hosted by the Manicaland Centre for Public Health Research, Zimbabwe. The project is particularly opportune given the very recent adoption of PrEP as a key component of the Zimbabwean national AIDS response and the subsequent roll-out of PrEP in all local clinics. The study will utilise a cluster randomised design of 44 clusters (22 Intervention:22 control) comprising on average 81 men in each cluster (total N = 3591) followed for 6 months (giving >80% power to detect a difference in PrEP initiation among men of 2% versus 8.5%). In intervention clusters we will identify initial distributors who will receive an HIVST kit for personal use and HIVST kits to distribute to local peers. These peers can subsequently become distributors, allowing the intervention to propagate through peer networks. A toll-free helpline will provide pre- and post-test support and an SMS-based risk assessment will expedite PrEP initiation at the clinic. We will conduct a performance (process) evaluation of the intervention. to assess implementation fidelity, causal mechanisms underlying trial effectiveness including how characteristics of peer networks affect outcomes. We will use the results of the study to quantify the population level impacts and cost-effectiveness of male peer to peer HIVST distribution strategies on the uptake of PrEP in HIV hyper-endemic settings using a fully calibrated individual-based mathematical model. The envisaged long-term impact of this research is the development of a generalizable, multicomponent male peer-based HIVST and PrEP uptake model for settings where HIV incidence is high.

项目总结 需要新的战略来吸引撒哈拉以南非洲(SSA)的男子进行艾滋病毒检测、治疗和 预防服务，以推动该流行病走向消灭。通过以下方式实现对艾滋病毒预防的次优参与 男性增加了他们感染艾滋病毒的风险，是妇女新感染艾滋病毒的重要驱动因素。艾滋病病毒自我- 测试(HIVST)解决了几个关键的基于设施的访问障碍和HIVST分布 预防艾滋病毒的男性同伴网络在特别行政区是可行的、可接受的和有效的。 该项目的目标是使用实施科学方法来确定HIVST的影响 在PrEP上通过男性社交网络进行分发，并提供电话支持和改进的风险感知 在津巴布韦东部男性中的吸毒率。该项目将利用与20- 艾滋病毒监测和行为研究年方案，在一个特征良好的人群队列中主持 由津巴布韦马尼卡兰公共卫生研究中心提供。考虑到这个项目是特别适时的 最近通过的《预防艾滋病方案》是津巴布韦国家艾滋病防治工作的一个重要组成部分， 随后在所有当地诊所推出PrEP。 这项研究将使用44个集群(22个干预：22个对照)的整群随机设计，包括 每组中平均有81名男性(总计N=3591人)接受6个月的跟踪(给予80%的力量来检测差异 男性开始PrEP的比例为2%，而男性为8.5%)。在干预群集中，我们将确定哪些初始总代理商 将收到供个人使用的HIVST试剂盒和分发给当地同行的HIVST试剂盒。这些对等点可以 随后成为分发者，允许干预通过对等网络传播。免费通行证 帮助热线将提供测试前和测试后支持，基于短信的风险评估将加快PrEP启动 在诊所。我们将对干预措施进行绩效(过程)评估。评估执行情况 试验有效性背后的保真度和因果机制，包括同伴网络的特征如何影响 结果。我们将利用研究结果来量化人口水平的影响和成本效益 在HIV高度流行环境中，男性点对点HIVST传播策略对PrEP感染的影响 完全校准的基于个人的数学模型。这项研究设想的长期影响是 基于男性同伴的可推广的多组分HIVST和PrEP摄取模型的建立 艾滋病毒发病率高的地方。