Enhanced Linkage to HIV Care Following Home-Based HIV Testing in Rural Uganda

乌干达农村地区家庭艾滋病毒检测后与艾滋病毒护理的联系得到加强

• 批准号: 8990904
• 负责人: Susan Maria Kiene
• 金额: $ 71.1万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-28 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8990904
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adult; Africa South of the Sahara; African; Anti-Retroviral Agents; Botswana; Caring; Client; Clinic; Cluster randomized trial; Communities; Continuity of Patient Care; Counseling; Country; Data; Disclosure; Disease; Effectiveness of Interventions; Epidemic; HIV; HIV Infections; HIV Seropositivity; Health Services Accessibility; Health care facility; Home environment; Home visitation; Hospital Referrals; House Call; Human immunodeficiency virus test; Individual; Inpatients; Intervention; Intervention Studies; Intervention Trial; Kenya; Life; Link; Malawi; Mediating; Modality; Natural History; Opportunistic Infections; Outcome; Outcome Study; Paper; Participant; Patients; Persons; Population; Prevention; Prevention program; Professional counselor; Prophylactic treatment; Provider; Public Health; Randomized; Research; Rural; Services; Social support; Staging; Testing; Time; Travel; Treatment outcome; Uganda; Viral; Viral Load result; Woman; antiretroviral therapy; arm; base; behavioral outcome; care seeking; care systems; compare effectiveness; cost; cost effective; cost effectiveness; follow-up; improved; intervention effect; men; mortality; novel strategies; patient home care; programs; public health relevance; randomized trial; social stigma; standard of care; trial comparing

 DESCRIPTION (provided by applicant): Throughout sub-Saharan Africa there is a pressing need to facilitate early and easier entry into HIV care and treatment; up to two-thirds of patients are lost to follow up between testing HIV positive and initiation of antiretroviral (ARV) treatment Timely linkage to care reduces mortality rates, improves treatment outcomes, and through its effect on viral load, decreases the likelihood of transmitting HIV to others. Home-based HIV testing and counseling (HBHCT), which identifies those who are HIV positive at earlier disease stages than other HIV testing approaches, is becoming a large component of many sub-Saharan African countries' HIV prevention programs, including Uganda's. HBHCT in the Ugandan setting may also be the most cost-effective HIV testing approach per person tested, per person testing for the first time, and per new HIV infection identified. The importance of HBHCT is particularly critical as access to HIV treatment increases and as "treatment as prevention" and "test and treat" approaches expand. Paper-based referral to care, sometimes adding follow-up home visits, is the most common linkage-to-care approach with HBHCT. Linkage to care may be especially challenging with HBHCT since the testing occurs in the home at a distance from a health facility, which may decrease the likelihood that individuals seek care. Our proposed intervention will provide the first evidence from a randomized trial testing a linkage intervention in the context of HBHCT in sub-Saharan Africa. We propose to test an intervention which enhances a linkage to care intervention tested in an urban Ugandan provider-initiated HIV testing setting and found to reduce time to HIV care among women and ARV initiation among men. The intervention facilitated linkage by: providing orientation to the HIV care system, counseling to help clients identify and reduce barriers to engagement in care, and assistance disclosing and identifying a treatment supporter. We will enhance the original intervention in order to increase its impact on multiple outcomes--beyond those studied the previous trial. Specifically, we propose to add an additional counseling session and increase the emphasis on seeking social support to overcome HIV-related stigma. We will compare our enhanced intervention to the standard-of-care for linkage and extend the findings of the previous intervention trial in a different public health-relevant HIV testing setting and context-HBHCT. More importantly, we will examine the impact of the intervention on HIV viral suppression as well as intermediate outcomes across the HIV care continuum. The aims of our project are: (1) In a cluster randomized trial compare the effectiveness of the enhanced linkage to care intervention vs. standard-of-care (paper based referrals) at achieving HIV viral suppression and intermediate outcomes of linkage to care, receipt of opportunistic infection prophylaxis, and ART initiation among those eligible for antiretroviral therapy (ART). (2) Using the standard-of-care group as a natural history control, collect longitudinal data on barriers to and facilitators of linkage to and retention in care and treatment and HIV viral suppression. (3) Estimate the cost and cost-effectiveness of the intervention, as compared to standard-of-care, in terms of major study outcomes.

 描述（由申请人提供）：在整个撒哈拉以南非洲地区，迫切需要促进早期和更容易地进入艾滋病毒护理和治疗;多达三分之二的患者 在艾滋病毒检测呈阳性和开始抗逆转录病毒治疗之间的随访中丢失及时与护理联系可降低死亡率，改善治疗结果，并通过其对病毒载量的影响，降低将艾滋病毒传播给他人的可能性。以家庭为基础的艾滋病毒检测和咨询（HBHCT），它确定那些谁是艾滋病毒阳性的早期疾病阶段比其他艾滋病毒检测方法，正在成为许多撒哈拉以南非洲国家的艾滋病毒预防计划，包括乌干达的一个重要组成部分。在乌干达环境中，HBHCT也可能是最具成本效益的艾滋病毒检测方法，每个人都进行了测试，首次测试，并确定每个新的艾滋病毒感染。随着获得艾滋病毒治疗的机会增加以及“治疗即预防”和“检测和治疗”方法的扩大，HBHCT的重要性尤为重要。基于纸张的转介护理，有时增加后续家访，是HBHCT最常见的护理联系方法。HBHCT与护理的联系可能特别具有挑战性，因为检测发生在远离卫生设施的家中，这可能会降低个人寻求护理的可能性。 我们提出的干预措施将提供来自随机试验的第一个证据，该试验在撒哈拉以南非洲的HBHCT背景下测试联动干预措施。我们建议测试的干预措施，加强了联系，在乌干达城市提供者发起的艾滋病毒检测环境中测试的护理干预，并发现减少时间艾滋病毒的妇女和抗逆转录病毒药物的启动之间的关系。干预措施通过以下方式促进了联系：向艾滋病毒护理系统提供指导，提供咨询以帮助客户识别和减少参与护理的障碍，并协助披露和确定治疗支持者。我们将加强最初的干预措施，以增加其对多种结果的影响-超越先前试验的研究。具体来说，我们建议增加一次额外的咨询会议，并更加重视寻求社会支持，以克服与艾滋病毒相关的耻辱。我们将比较我们的强化干预措施与标准护理的联系，并在不同的公共卫生相关的艾滋病毒检测环境和背景下，HBHCT扩展以前的干预试验的结果。更重要的是，我们将研究干预措施对艾滋病毒抑制的影响以及整个艾滋病毒护理连续体的中间结果。我们的项目的目的是：（1）在一项随机分组试验中，比较加强与护理干预的联系与标准护理（基于纸张的转诊）在实现HIV病毒抑制方面的有效性，以及在符合抗逆转录病毒治疗（ART）条件的患者中与护理、接受机会性感染预防和ART启动联系的中间结果。(2)使用标准治疗组作为自然史对照，收集关于护理和治疗以及HIV病毒抑制的联系和保留的障碍和促进因素的纵向数据。(3)根据主要研究结果，与标准治疗相比，估计干预的成本和成本效益。