Improving HIV testing, linkage, and retention in care for men through U=U messaging

通过 U=U 信息传递改善男性的 HIV 检测、联系和护理保留

• 批准号: 10626959
• 负责人: Alison Meredith Buttenheim
• 金额: $ 54.37万
• 依托单位: DESMOND TUTU HIV FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10626959
• 关键词: AIDS prevention; Acceleration; Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Africa South of the Sahara; Area; Behavioral Sciences; Caring; Clinic; Collaborations; Communicable Diseases; Communication; Communities; Continuity of Patient Care; Counseling; Country; Coupled; Data; Effectiveness; Effectiveness of Interventions; Epidemic; Epidemiology; Evaluation; Fright; Gender; Goals; Government; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Benefit; High Prevalence; Human immunodeficiency virus test; Incidence; Income; Institution; Intervention; Knowledge; Learning; Methods; Outcome; Participant; Penetration; Persons; Prevalence; Process; Province; Randomized; Research; Resources; Safe Sex; Sexual Partners; Shapes; Site; South Africa; Testing; Unsafe Sex; Viral; Viral Load result; Woman; Work; antiretroviral therapy; anxiety reduction; behavioral economics; cis-male; clinical practice; contextual factors; effectiveness evaluation; effectiveness-implementation RCT; experience; future implementation; human centered design; implementation barriers; implementation efforts; implementation facilitation; improved; innovation; insight; male health; men; mortality risk; peer; primary outcome; prototype; randomized trial; secondary outcome; service delivery; service uptake; sexual HIV transmission; standard of care; successful intervention; testing services; testing uptake; theories; therapy adherence; tool; transmission process; treatment adherence; treatment as prevention; uptake; yeast two hybrid system

PROJECT ABSTRACT Increasing the coverage of HIV testing and treatment among people living with HIV (PLHIV) is essential for ending the global AIDS epidemic. Unfortunately, compared to women, men living with HIV (MLHIV) are less likely to know their HIV status, start anti-retroviral treatment, or achieve viral suppression. Given that new HIV infections among women are driven, in part, by men’s testing and treatment gaps, reducing the gender gap in testing uptake, treatment initiation and achievement of viral suppression by men must be prioritized in order to accelerate the decline in HIV incidence among women, improve men’s HIV-related health outcomes and achieve the UNAIDS 95-95-95 goals by 2030. In this study, we evaluate the effectiveness of Undetectable Equals Untransmittable or “U=U” messaging for closing the gender gap in the HIV cascade. The U=U message communicates the compelling idea that PLHIV who take ART and have an undetectable viral load (<200 copies/mL) cannot sexually transmit HIV. Particularly for men, the U=U message has the potential to accelerate progress towards the 95-95-95 targets by: 1) reducing anxiety associated with HIV testing (1st 95); 2) encouraging people who test HIV-positive to initiate ART (2nd 95); and 3) reducing fear of transmitting HIV to sexual partners by promoting treatment adherence to achieve viral suppression (3rd 95). While there is a growing knowledge of Treatment as Prevention (TasP)/U=U among PLWH in Western countries, the reach and penetration of the U=U message in sub-Saharan Africa has been limited and few studies have tested the impacted of accessible U=U messages on ART uptake and adherence in sub-Saharan Africa. Building on our prior work on U=U messaging informed by behavioral economics and human-centered design, we propose to conduct two hybrid type 1 effectiveness-implementation randomized controlled trials to evaluate the impact of U=U messages on men’s uptake of community-based HIV testing and treatment initiation (Aim 1), and achievement of viral suppression (Aim 2). We will also conduct a multi-method evaluation to inform future implementation of U=U messaging interventions. To improve the generalizability of our findings, we will conduct our study in two provinces in South Africa (Western and Eastern Cape). If effective, our intervention can shape global HIV testing and treatment counselling guidelines and practices. Our expert, multi-institutional collaborations will allow us to apply previous research findings, leverage unique implementation platforms and resources, and rapidly disseminate our findings.

项目摘要 提高艾滋病毒感染者 (PLHIV) 的艾滋病毒检测和治疗覆盖率对于 结束全球艾滋病流行。不幸的是，与女性相比，男性艾滋病毒感染者 (MLHIV) 的感染率较低 可能了解自己的艾滋病毒状况、开始抗逆转录病毒治疗或实现病毒抑制。鉴于新的艾滋病毒 女性感染的部分原因是男性的检测和治疗差距，从而缩小了性别差距 必须优先考虑男性的检测摄取、治疗开始和实现病毒抑制，以便 加速女性艾滋病毒发病率下降，改善男性艾滋病毒相关健康结果，并实现 到 2030 年，联合国艾滋病规划署 95-95-95 目标。在这项研究中，我们评估了 UnDetectable Equals 的有效性 不可传播或“U=U”消息，用于缩小艾滋病毒级联中的性别差距。 U=U 消息 传达了一个令人信服的想法，即接受 ART 且病毒载量无法检测到的 PLHIV（<200 拷贝/mL）不能通过性行为传播艾滋病毒。特别是对于男性来说，U=U 信息有可能加速 通过以下方式实现 95-95-95 目标的进展： 1) 减少与 HIV 检测相关的焦虑（第 95 个）； 2）鼓励 HIV 检测呈阳性以启动 ART 的人（第 95 次）； 3) 减少将艾滋病毒传染给性伴侣的恐惧 通过促进治疗依从性来实现病毒抑制（3rd 95）。虽然人们的认识不断增长 治疗即预防 (TasP)/U=U 在西方国家的 PLWH 中，U=U 的覆盖范围和渗透率 撒哈拉以南非洲地区的信息有限，很少有研究测试可访问的 U=U 的影响 关于撒哈拉以南非洲地区抗逆转录病毒治疗的采用和坚持的信息。以我们之前在 U=U 消息传递方面的工作为基础 根据行为经济学和以人为本的设计，我们建议进行两种混合类型 1 有效性实施随机对照试验，评估 U=U 信息对男性的影响 开展基于社区的艾滋病毒检测和治疗（目标 1），并实现病毒抑制 （目标 2）。我们还将进行多方法评估，为 U=U 消息传递的未来实施提供信息 干预措施。为了提高我们研究结果的普遍性，我们将在南方的两个省份进行研究 非洲（西开普省和东开普省）。如果有效，我们的干预措施可以塑造全球艾滋病毒检测和治疗 咨询指南和实践。我们的专家、多机构合作将使我们能够应用以前的 研究成果，利用独特的实施平台和资源，快速传播我们的研究成果 发现。

项目成果

Improving HIV testing, linkage, and retention in care among South African men through U=U messaging: A study protocol for two sequential hybrid type 1 effectiveness- implementation randomized controlled trials.

通过 U=U 信息传递改善南非男性的 HIV 检测、联系和护理保留：两项连续混合 1 型有效性实施随机对照试验的研究方案。

• DOI: 10.21203/rs.3.rs-3349696/v1
• 发表时间: 2023
• 期刊: Research square
• 作者: Medina-Marino,Andrew;Sibanda,Nkosiyapha;Putt,Mary;JosephDavey,Dvora;Smith,Phillip;Thirumurthy,Harsha;Bekker,Linda-Gail;Buttenheim,Alison
• 通讯作者: Buttenheim,Alison