Dyadic-Based Diagnosis, Care, & Prevention for HIV Discordant Couples in Tanzania

 描述（由申请人提供）：尽管在撒哈拉以南非洲地区进行了20年的大量艾滋病毒预防工作，但该流行病继续产生破坏性影响。本区域艾滋病治疗和护理范围的扩大提供了重要的救命服务，但也增加了预防和护理工作的协调和服务提供的复杂性。如何最好地结合联合收割机干预策略（预防，治疗，护理，行为，生物医学）是该领域的一个紧迫问题。我们认为，联合收割机干预措施的最佳方式是基于协同作用，干预措施的组成部分直接相互加强，而不仅仅是方案是否同时发生。此外，需求巨大，服务有限。为了最大限度地减少人口中的艾滋病毒发病率，必须对那些最有可能传播和感染艾滋病毒的人采取更密集的干预措施。我们建议在坦桑尼亚基萨拉韦对1700对年龄在18-45岁之间的夫妇进行一项前瞻性观察性研究，这些夫妇将获得干预措施，提供：（1）在家庭中提供艾滋病毒自我检测试剂盒和检测前咨询，（2）为检测阳性者提供咨询和转诊中心，（3）为确认感染艾滋病毒的夫妇提供护理和治疗;以及（4）HIV血清不一致夫妇中阴性伴侣获得暴露前预防。将对所有1700对夫妇（3400人）进行基线和18个月的调查，并在18个月时进行艾滋病毒检测。作为一对儿参与护理的阳性伴侣将在18个月时进行CD 4和病毒载量检测。通过自我检测和进入护理确定的所有HIV血清不一致的夫妇（估计为50对夫妇）也将进行额外的6个月和12个月的调查，我们将从每次诊所访视中收集持续的临床数据。将在入组时收集生物识别数据（指纹），并与咨询和转诊中心以及艾滋病毒治疗中心进行所有接触，以便将服务的使用与调查数据联系起来。的 如果发现了令人信服的疗效，并确定了安全性和可接受性，本研究将使项目进入适当的随机对照试验。

 DESCRIPTION (provided by applicant): Despite 20 years of considerable HIV prevention efforts in Sub Saharan Africa the epidemic continues to have devastating impacts. The advent of expansion of treatment and care for AIDS in the region has provided important and lifesaving services, but has also added complexity to coordination and service delivery across prevention and care efforts. How to best combine intervention strategies (prevention, treatment, care, behavioral, biomedical) is a pressing question in the field. We believe that the best way to combine interventions is based on synergy, with intervention components directly reinforcing one another, not just whether programs occur simultaneously. In addition, needs are great and services limited. To achieve the maximum population-level reduction in HIV incidence it is important that those at greatest risk of transmitting and acquiring HIV receive more intensive interventions. We propose to conduct a prospective observational study of 1700 couples aged 18-45 years in Kisarawe, Tanzania who will be provided an intervention that offers: (1) HIV self-testing kits and pre-test counseling provided at the household, (2) linkage to a counseling and referral center for those who test positive, (3) facilitated enrollment to care and treatment for couples with confirmed HIV infection; and (4) access to pre-exposure prophylaxis for the negative partner in a HIV sero-discordant couple. A baseline and 18- month survey will be administered to all 1700 couples (3400 individuals), with a HIV and test conducted at 18-months. Positive partners who engaged in care as a dyad will have a CD4 and viral load test conducted at 18 months. All HIV sero-discordant couples identified through self-testing and entering care (estimated to be 50 couples) will also be administered an additional 6- and 12-month survey, and we will collect ongoing clinical data from each clinic visit. Biometric data (fingerprint) will be collected at enrollment, and all encounters with the counseling and referral center, and HIV treatment center, to allow linking of utilization of services with survey data. The study will position the project to advance to an appropriately powered randomized controlled trial should compelling efficacy be found, and safety and acceptance be established.