Enhancing communication on relationship preservation, safer conception and PrEP to promote HIV testing

项目摘要 优化艾滋病毒检测的使用对于在撒哈拉以南非洲实现95-95-95目标至关重要。新的30% 感染发生在已婚或同居的夫妇中，最大限度地在已婚或同居的个人中进行检测， 可能有一天会在严重的异性恋关系已被确定为最具成本效益的一个 遏制这一流行病的战略。在整个撒哈拉以南非洲，生育受到高度重视， 关系破裂和失去生育能力仍然是艾滋病毒检测的重大障碍。的 扩大暴露前预防（PrEP）的可用性为应对这些恐惧提供了机会， 战略性沟通（NOT-MH-21-105），使夫妇确信他们有能力拥有一个健康的家庭， 如果一个或两个成员都是艾滋病毒阳性。我们的长期目标是利用日益增长的PrEP可用性 以确定是否以及如何将沟通策略集中在关系维护和更安全的概念上 可以增加测试和进入治疗（抗逆转录病毒疗法）或预防（PrEP）之间的合作伙伴， 乌干达的个人。我们最近在乌干达的援助范围内成功地试行了这一传播战略， 合作伙伴通知程序（APN）。在本次R34中，我们将：（1）进行形成性研究，以扩大 将宣传战略转化为覆盖面更广的多组成部分干预措施;以及（2）开展 干预措施，PrEPing健康家庭。为了实现目标1，我们将与社区咨询委员会合作， (CAB)提供者的a）创建通信材料（小册子，脚本）和咨询协议量身定制 为客户和合作伙伴提供APN和产前护理（ANC）中的一系列夫妇检测途径。作为 CAB提供商在此开发阶段与客户和合作伙伴一起试用材料和跟踪系统， 研究人员将进行实地观察和定性访谈，重点是可行性和可接受性， 提供经修订的干预材料。为了实现目标2，我们将收集APN和ANC的基线数据 在两个大型公共医疗机构的诊所超过九个月。然后将随机分配研究中心， 在接下来的九个月里，为健康家庭或他们现有的沟通方式（常规护理）做准备。 我们将通过APN/ANC中的干预跟踪来收集可行性和可接受性的混合方法数据 登记册、客户离职调查以及与客户、合作伙伴和供应商的定性访谈。通过寄存器 提取，我们将检查与更大规模试验（伴侣HIV）相关的结局的有限疗效 测试，PrEP/ART的客户服务摄取启动），并探索潜在的主持人。总体而言，结果将 在一个有前途的新的沟通战略（NOT-MH-21-105）中产生重要的见解， 艾滋病毒的治疗和预防护理的级联，并为我们准备了一个大规模的集群， 随机对照试验，以确定对PrEP/ART测试和启动的影响。

PROJECT SUMMARY Optimizing uptake of HIV testing is critical to meeting 95-95-95 goals in sub-Saharan Africa. As 30% of new infections in occur within married or cohabitating couples, maximizing testing among individuals who are or may someday be in serious heterosexual relationships has been identified as one of the most cost-effective strategies to curb the epidemic. Childbearing is highly valued throughout Sub-Saharan Africa, and fears of relationship dissolution and loss of the ability to have children remain significant barriers to HIV testing. The expanding availability of pre-exposure prophylaxis (PrEP) presents an opportunity to counter these fears with strategic communication (NOT-MH-21-105) that reassure couples of their ability to have a healthy family even if one or both members are HIV positive. Our long-term objective is to leverage the growing availability of PrEP to determine if and how a communication strategy focused on relationship preservation and safer conception can increase testing and entry into treatment (antiretroviral therapy) or prevention (PrEP) among partnered individuals in Uganda. We recently successfully piloted this communication strategy within Uganda’s assisted partner notification program (APN). In this R34, we will: (1) conduct formative research to expand the communication strategy into a multi-component intervention with broader reach; and (2) conduct a pilot trial of the intervention, PrEPing Healthy Families. To achieve Aim 1, we will work with a community advisory board (CAB) of providers to a) create communication materials (brochures, scripts) and counseling protocols tailored to clients and partners across the array of couples’ testing pathways in APN and antenatal care (ANC). As CAB providers pilot materials and tracking systems with clients and partners during this development phase, study staff will conduct field observations and qualitative interviews focused on feasibility and acceptability, informing revised intervention materials. To achieve Aim 2, we will collect baseline data at APN and ANC clinics within two large public healthcare facilities over nine months. Sites will then be randomized to implement PrEPing Healthy Families or their existing communication approach (usual care) over the next nine months. We will collect mixed-methods data on feasibility and acceptability through intervention tracking in APN/ANC registers, client exit surveys, and qualitative interviews with clients, partners and providers. Through register extraction, we will examine limited efficacy on outcomes that would be relevant to a larger trial (partner HIV testing, client service uptake initiation of PrEP/ART), and explore potential moderators. Overall, results will yield important insights in a promising new communication strategy (NOT-MH-21-105) that may connect more individuals to the HIV cascades of care for treatment or prevention and prepare us for a large-scale, cluster randomized controlled trial to determine impact on testing and initiation of PrEP/ART.