Self-Conducted HIV Tests - Improving HIV Prevention in Key Populations

自行进行艾滋病毒检测——改善重点人群的艾滋病毒预防

• 批准号: 8898221
• 负责人: Sheri Ann Lippman
• 金额: $ 17.71万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8898221
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adoption; Africa South of the Sahara; African; Attitude; Behavior; Behavioral; Blood; Caring; Clinic; Communities; Controlled Environment; Counseling; Country; Data; Decision Making; Detection; Discrimination; Early Diagnosis; Enrollment; Ensure; Epidemic; Ethnography; Fingers; Frequencies; Fright; General Population; Government; Government Programs; HIV; HIV Infections; HIV Seropositivity; Health Personnel; High Prevalence; Human immunodeficiency virus test; Individual; Infection; Intervention; Life; Light; Liquid substance; Oral; Pattern; Persons; Pharmacy facility; Phase; Pilot Projects; Population; Prevalence; Prevention; Prevention program; Prevention strategy; Province; Recruitment Activity; Research; Risk; Risk Behaviors; Risk Reduction; Safe Sex; Services; Sexual Transmission; South Africa; Stigmatization; Surveys; Test Result; Testing; United States National Institutes of Health; base; burden of illness; cohort; condoms; experience; falls; follow-up; high risk; high risk sexual behavior; improved; men; men who have sex with men; preference; programs; public health relevance; sex; sex risk; social stigma; surveillance data; treatment program; uptake

DESCRIPTION (provided by applicant): HIV testing can decrease risky sexual behavior among HIV-positive men who have sex with men (MSM) and provide a gateway into HIV/AIDS care and treatment. MSM in South Africa, however, do not currently utilize clinic-based HIV testing at a rate commensurate with their risk and too few know their status. In South Africa programs have largely failed to engage Men who have Sex with Men (MSM): a population with an extremely high burden of disease and high rates undiagnosed HIV infections. Recent bio-behavioral surveillance data undertaken by this investigative team in Mpumalanga Province demonstrated prevalence among MSM at above 30%, with 54% of HIV positive MSM unaware of their status prior to survey participation. Urgently needed strategies to expand HIV testing among MSM in South Africa may include new HIV self-testing kits that offer an alternative to clinic-based testing. Self-tests expand testing beyond the clinic, which is of particular significance for MSM and other key populations who require more frequent testing and are less comfortable accessing clinic services. While self-conducted HIV tests could expand the package of testing options in South Africa, thus facilitating earlier HIV detection and treatment, there isa lack of information regarding acceptability, feasibility, or potential behavioral impacts of introducing the HIV self-test among African MSM. To address this gap, we propose to determine the acceptability (Aim 1), the feasibility (Aim 2) and the behavioral impacts (aim 3) of HIV self-testing among South African MSM currently enrolled in NIH-sponsored cohorts (R01AI092892, Lane). We will explore whether self-testing will be used by South African MSM; how, when, where, what kind, and with whom self-tests are utilized; how sexual risk behaviors may be modified by introducing self-test kits into this community; and strategies to ensure linkage to care following self-testing in this underserved and high risk population. We will achieve these aims by first conducting a pre-pilot study to explore initial acceptability of both blood-based and oral fluid self-tests and to understand what is necessary to ensure safe and correct usage of both self-tests in a controlled environment. We will then conduct a pilot study, where we will distribute self-testing kits to HIV-negative MSM and follow their use over the course of 6 months. We will implement this study among MSM participating in cohorts recruited from the high prevalence Gert Sibande and Ehlanzeni districts. This proposal offers a unique opportunity to explore self-testing among MSM within established NIH-supported cohorts where a productive research partnership is already underway. The proposed research will provide information critical to understanding how self-tests would fit into a package of expanded testing options for high risk communities experiencing barriers to clinic-based testing and support future research to determine whether introduction of self-testing can improve early detection and entry to care and facilitate safer sexual behaviors, thus leading to prevention gains.

描述（由申请人提供）：艾滋病毒检测可以减少艾滋病毒阳性的男男性行为者（MSM）的危险性行为，并提供进入艾滋病毒/艾滋病护理和治疗的途径。然而，南非的男男性行为者目前利用诊所艾滋病毒检测的速度与他们的风险不相称，而且知道自己状况的人太少。在南非，方案在很大程度上未能让男男性行为者参与进来：这是一个疾病负担极高、未确诊艾滋病毒感染率很高的人群。该调查小组最近在普马兰加省进行的生物行为监测数据显示，男男性行为者的患病率超过30%，54%的艾滋病毒阳性男男性行为者在参加调查之前不知道自己的状况。在南非扩大男男性行为者艾滋病毒检测的迫切需要的战略可能包括新的艾滋病毒自我检测试剂盒，它提供了一种替代诊所检测的方法。自我检测将检测范围扩大到诊所以外，这对男男性行为者和其他需要更频繁检测且不太愿意获得诊所服务的关键人群特别重要。虽然自我进行的艾滋病毒检测可以扩大在南非的测试方案，从而促进早期的艾滋病毒检测和治疗，伊萨缺乏有关在非洲男男性行为者中引入艾滋病毒自我检测的可接受性，可行性或潜在行为影响的信息。为了解决这一差距，我们建议，以确定可接受性（目标1），艾滋病毒自我检测的可行性（目标2）和行为的影响（目标3），目前在美国国立卫生研究院赞助的队列（R 01 AI 092892，巷）南非男男性接触者。我们将探讨是否自我测试将被南非男男性接触者使用;如何，何时，何地，什么样的，以及与谁的自我测试被利用;如何性风险行为可能会被修改，通过引入自我测试工具包到这个社区;和策略，以确保链接到照顾自我测试后，在这个服务不足和高风险的人群。我们将首先进行一项试点前研究，探讨血液和血液制品的初步可接受性， 口腔液体自检，并了解什么是必要的，以确保安全和正确的使用这两个自检在一个受控的环境。然后，我们将进行一项试点研究，我们将向艾滋病毒阴性的男男性行为者分发自我检测试剂盒，并在6个月内跟踪其使用情况。我们将在从高患病率的Gert Sibande和Ehlanzeni地区招募的MSM参与队列中实施这项研究。这项建议提供了一个独特的机会，探索自我测试中男同性恋者在既定的NIH支持的队列，其中一个富有成效的研究伙伴关系已经在进行中。拟议的研究将提供关键信息，以了解自我测试如何适合于经历基于诊所的测试障碍的高风险社区的一揽子扩展测试选项，并支持未来的研究，以确定引入自我测试是否可以改善早期检测和进入护理并促进更安全的性行为，从而导致预防收益。