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

项目摘要 需要采取新的战略，使撒哈拉以南非洲（SSA）的男性参与艾滋病毒检测、治疗和预防。 预防服务，推动疫情走向消灭。艾滋病毒预防工作的参与欠佳， 男性增加了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。HIV自身 艾滋病毒检测（HIVST）解决了几个关键的设施为基础的访问障碍和HIVST分布，通过利用 在撒哈拉以南非洲，男性同伴网络预防艾滋病毒是可行的，可接受的和有效的。 该项目的目标是采用科学的方法来确定艾滋病毒/艾滋病防治的影响 通过男性社交网络分发，并提供基于电话的支持和改善的风险认知， 在津巴布韦东部的男性中。该项目将利用与20个国家相关的基础设施和数据， 在一个特征明确的人群队列中开展为期一年的艾滋病毒监测和行为研究方案， 由津巴布韦马尼卡兰公共卫生研究中心提供。该项目是特别及时的， 最近通过的PrEP是津巴布韦国家艾滋病应对措施的关键组成部分， 随后在所有当地诊所推广PrEP。 本研究将采用44个分组（22个干预组：22个对照组）的分组随机化设计，包括 每群平均81名男性（总N = 3591）随访6个月（检测差异的把握度> 80 在PrEP启动中，男性为2%对8.5%）。在干预集群中，我们将确定初始分销商， 将收到一个供个人使用的HIVST工具包和分发给当地同龄人的HIVST工具包。这些同行可以 随后成为分发者，允许干预通过对等网络传播。一个免费 马林将提供测试前和测试后的支持，基于SMS的风险评估将加快PrEP的启动 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 忠诚度、试验有效性背后的因果机制，包括同侪网络特征如何影响 结果。我们会根据研究结果，量化各项措施对人口水平的影响和成本效益， 在艾滋病毒高度流行的环境中使用PrEP的男性点对点HIVST分布策略 完全校准的基于个体的数学模型。这项研究预期的长期影响是 开发一个可推广的、多成分的、基于男性同伴的HIVST和PrEP摄取模型， 那里艾滋病发病率很高。

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.