ITEST: Innovative Tools to Expand Youth-Friendly HIV Self-Testing

ITEST：扩大青少年友好的艾滋病毒自我检测的创新工具

• 批准号: 10252954
• 负责人: Juliet Iwelunmor
• 金额: $ 136.69万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10252954
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Africa; Africa South of the Sahara; African; American; Anal Sex; Area; Behavioral; Benchmarking; Chlamydia; Clinical Trials Data Monitoring Committees; Communities; Country; Creativeness; Data; Decentralization; Development; Effectiveness; Ensure; Epidemic; Evaluation; Fright; Goals; Gonorrhea; Government; Guidelines; HIV; HIV Infections; HIV Seronegativity; Human immunodeficiency virus test; Incidence; Individual; Infection; Institutional Review Boards; Intervention; Learning; Link; Local Government; Mentorship; Modality; National Institute of Child Health and Human Development; Newly Diagnosed; Nigeria; Nigerian; Outcome; Patient Self-Report; Phase; Policies; Prevention strategy; Preventive; Preventive service; Privacy; Procedures; Process; Public Health; Randomized; Randomized Controlled Trials; Request for Applications; Research; Research Priority; Risk; Sampling; Services; Sexually Transmitted Diseases; Social Problems; Social support; Specimen; Structure; Syphilis Serodiagnosis; Testing; United States National Institutes of Health; Vagina; World Health Organization; Youth; age group; aged; apprenticeship; authority; base; community based participatory research; condoms; design; disparity reduction; effectiveness evaluation; experience; experimental study; high risk; implementation intervention; implementation strategy; improved; innovation; low and middle-income countries; multidisciplinary; pre-exposure prophylaxis; preference; prevent; prevention service; primary outcome; recruit; resilience; response; secondary outcome; self testing; service uptake; skills; social; social stigma; success; supportive environment; testing services; therapy development; tool; transmission process; trial readiness; uptake; willingness

ABSTRACT HIV incidence remains high among youth aged 14-24 in Sub-Saharan Africa, thus underscoring the importance of interventions to prevent HIV in this age group. Nigerian youth are at the epicenter of an expanding HIV crisis, with the second largest number of new youth HIV infections of any country. Yet fewer than one in five Nigerian youth have ever been HIV tested. Young people are often framed as the fraught victims of new HIV infections, instead of recognizing their resilience and power in advancing effective response to the epidemic. Conventional expert-driven, top-down interventions have largely failed. Innovative solutions that leverage the resourcefulness and resilience of youth are sorely needed. In this proposal, we will develop innovative youth-friendly HIV self-testing services based on open challenges and apprenticeships that are informed by a youth participatory action research framework. Open challenges solicit solutions from the community and then implement the best solutions, while apprenticeship builds local capacity for youth-led projects to increase the likelihood of success and ensure comprehensive evaluation. Three randomized controlled trials based on open challenges have led to improved rates of HIV testing and condom use among at-risk youth, but none of these approaches have been in Africa. These participatory approaches will be used to identify innovative HIV self-testing strategies that meet the specific needs of Nigerian youth. Each strategy will have a comprehensive plan for enhancing HIV prevention (including HIV pre- exposure prophylaxis and behavioral approaches) among at-risk youth. Two HIV self-testing strategies will be selected by judges as semi-finalists and evaluated in separate local government area pilots (UG3 phase). Once the project meets stringent requirements demonstrating trial readiness and pilot effectiveness, a single strategy will be evaluated in a pragmatic, cluster randomized controlled trial in 24 local government areas of Nigeria (UH3 phase). The intervention development process will build capacity for decentralized HIV self- testing, drawing on the strengths, creativity, and engagement of Nigerian youth. Leveraging our extensive experience organizing HIV research in Nigeria, we propose the following specific aims: (1) To use open challenges and apprenticeship to develop new HIV self-testing services; (2) To evaluate the effectiveness of two semi-finalist participatory interventions on HIV testing and other key prevention services among at-risk, HIV-negative youth (14-24years old); (3) To determine the effectiveness of a finalist participatory intervention on HIV testing and other key HIV prevention outcomes in 24 areas using a stepped wedge, pragmatic randomized controlled trial. The overarching goal is not to create a monolithic “one-size fits all” HIV self-testing strategy, but rather to demonstrate that open challenges can engage and inspire youth to develop innovative and effective HIV services. Our focus on open challenges and tailoring services to youth resonates with NICHD, NIH, and US government strategic priorities.

摘要 撒哈拉以南非洲14-24岁青年的艾滋病毒发病率仍然很高，从而凸显了 在这个年龄组预防艾滋病毒的干预措施的重要性。尼日利亚青年正处于一场 艾滋病毒危机不断扩大，新感染艾滋病毒的青年人数在所有国家中排名第二。更少 五分之一的尼日利亚青年接受过艾滋病毒检测。年轻人经常被认为是 新感染艾滋病毒的受害者，而不是认识到他们在推进有效治疗方面的复原力和力量 应对疫情。传统的专家驱动的、自上而下的干预措施基本上都失败了。创新 迫切需要利用青年的智慧和复原力的解决办法。在本提案中，我们将 在开放式挑战和学徒制的基础上，发展创新的青年友好型艾滋病毒自我检测服务 这是由一个青年参与行动研究框架提供信息。公开挑战征求解决方案 社区，然后实施最佳解决方案，而学徒制则为青年主导的地方能力建设 项目，以增加成功的可能性，并确保全面的评价。三个随机 基于公开挑战的对照试验提高了艾滋病毒检测率和安全套使用率， 但这些方法都没有在非洲使用过。将采用这些参与性办法， 确定创新的艾滋病毒自我检测战略，以满足尼日利亚青年的具体需求。每个策略 将有一个全面的计划，以加强艾滋病毒预防（包括艾滋病毒暴露前预防， 行为方法）。两种艾滋病毒自我检测策略将由法官选择， 半决赛选手，并在单独的地方政府地区试点（UG 3阶段）进行评估。一旦项目满足 严格的要求，证明试验准备就绪和试点有效性，一个单一的战略将 在尼日利亚的24个地方政府地区进行的一项实用的、集群随机对照试验中进行了评价（UH 3 阶段）。制定干预措施的进程将建立分散进行艾滋病毒自我检测的能力， 关于尼日利亚青年的力量、创造力和参与度。利用我们丰富的经验 在尼日利亚组织艾滋病毒研究，我们提出以下具体目标：（1）利用开放的挑战， 发展新的爱滋病病毒自我测试服务;（2）评估两个半决赛项目的成效 * 在高危、艾滋病毒抗体阴性的儿童中， 青年（14- 24岁）;（3）确定艾滋病毒最终参与性干预措施的效果 在24个地区使用阶梯式楔形，务实的随机 对照试验首要目标不是建立一个单一的“一刀切”艾滋病毒自我检测战略， 而是要证明，开放的挑战可以吸引和激励青年发展创新和 有效的艾滋病毒服务。我们对开放性挑战和为青年量身定制服务的关注与NICHD产生了共鸣， 国家卫生研究院和美国政府的战略重点。