High-yield HIV Testing, Facilitated Linkage to Care, and Prevention for Female Youth in Kenya

肯尼亚青年女性的高成果艾滋病毒检测、促进与护理和预防的联系

• 批准号: 9115046
• 负责人: Kawango Agot
• 金额: $ 32.62万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9115046
• 关键词: AIDS prevention; Address; Adherence; Adolescent; Adult; Africa South of the Sahara; African; Aftercare; Age; Biological Markers; CD4 Lymphocyte Count; Caring; Communities; Continuity of Patient Care; Cost Effectiveness Analysis; Cost-Benefit Analysis; Counseling; County; Data; Electronics; Elements; Enrollment; Epidemic; Epidemiology; Female; Funding; Gender; Government; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; High Prevalence; Home environment; Human immunodeficiency virus test; Improve Access; Incidence; Individual; Instruction; Intervention; Intervention Trial; Interview; Kenya; Lead; Learning; Link; Liquid substance; Location; Logistic Regressions; Logistics; Measures; Methodology; Methods; Modality; Morbidity - disease rate; Newly Diagnosed; Participant; Pattern; Perinatal; Population; Pregnancy in Adolescence; Prevalence; Prevention; Prevention program; Preventive Intervention; Primary Prevention; Provider; Province; Randomized; Regression Analysis; Research Personnel; Risk; Risk Reduction Behavior; Scientist; Secondary Prevention; Seminal; Services; Surveys; Survival Analysis; System; Testing; Text; Time; United States National Institutes of Health; Vertical Disease Transmission; Viral Load result; Vulnerable Populations; Woman; Work; Youth; age group; aged; base; behavioral economics; biobehavior; care seeking; comparative; condoms; cost; cost effective; cost effectiveness; design; economic evaluation; economic incentive; evidence base; financial incentive; follow-up; girls; high risk; implementation science; improved; innovation; male; mortality; novel; oral HIV; preference; prevent; prevention service; scale up; seroconversion; success; targeted delivery; technological innovation; transmission process; trial design; uptake; young woman

 DESCRIPTION (provided by applicant): HIV prevalence in sub-Saharan Africa (SSA) is highest of any global region, and females in SSA are at highest risk. In Kenya, adult HIV prevalence has declined nationally except in the west (Nyanza). HIV incidence among Kenyan youth aged 15-24 did not change between 2007-12, suggesting that more innovative and effective HIV prevention and treatment is urgently needed. Women ages 15-24 in Kenya are 2-3 times more likely than males to be HIV-infected. Related risks of teen pregnancy contribute to vertical HIV. There is a wide gap between these epidemiologic risks and targeted delivery of efficacious interventions for young women to get testing, prevention or linkage to HIV treatment. Our scientific team including researchers, implementers, and Ministry of Health, is productively engaged in a current gender-specific combination HIV prevention study for youth that the proposed work will leverage. We propose an implementation science framework to address the HIV prevention and treatment continuum that will inform best practices in identifying high-need young women, providing testing options, and primary HIV prevention as well as linkage to HIV care, in SSA. AIM 1: We propose to identify female youth ages 15-24 years at risk for HIV in Nyanza, Kenya who have not had a HIV test within the past six months, utilizing 1) community-based (n≥500) and 2) home-based (n≥500) 'seek' strategies and compare HIV test uptake and prevalence (yield). Logistic regression analysis will determine which recruitment strategy yields a higher rate of newly diagnosed HIV infection. Enrolled young women (n≥1,000) will be offered 1) HIV oral fluid self-testing (OST), 2) staff-aided testing (HTC) and 3) standard provider/facilit-based testing to determine this population's preference for location and modality of HIV testing services based on uptake patterns. Multinomial logistic regression will be used to understand which testing approaches are preferred by female youth. AIM 2: We will pilot and evaluate an adaptive intervention ('SMART' trial) to link HIV-positive female youth (anticipated n=100) to HIV treatment. We will randomize participants to receive text-messages/SMS or standard referral; those who do not link to care will then be re- randomized to receive 1) one-time financial incentive to link to care vs. 2) SMS reminders. We will also use the SMS platform to deliver targeted messages around recommended 6-month HIV re-testing, and risk reduction behaviors, to high-risk HIV negatives to support high-impact prevention. We will re-test a random subset of these HIV-negatives (n=100) to document HIV status at 12 months, and survey them regarding HIV testing and prevention service access between baseline and follow-up. AIM 3: We will conduct an economic evaluation, using both cost-effectiveness and cost-benefit analyses, to determine the relative utility of each of the Aims 1-2 seek, test, link, and prevention interventions. We will share study findings with Government of Kenya to inform design of their planned national electronic HIV SMS system, strengthen national rollout for HIV self-testing, and enhance high-impact HIV prevention and treatment for the most vulnerable young women.

 描述（由适用提供）：撒哈拉以南非洲（SSA）的HIV患病率最高，在任何全球地区，SSA的女性处于最高风险。在肯尼亚，除西方（Nyanza）以外，成年艾滋病毒的患病率在全国范围内下降。肯尼亚青年中15-24岁的艾滋病毒事件在2007 - 12年之间没有改变，这表明迫切需要更具创新性和有效的HIV预防和治疗。肯尼亚15-24岁的妇女比男性受到HIV感染的可能性是男性的2-3倍。青少年怀孕的相关风险会导致垂直艾滋病毒。这些流行病学风险与有效提供有效的干预措施之间的差距很大，以便年轻女性获得测试，预防或与HIV治疗联系。我们的科学团队在内，包括研究人员，实施者和卫生部，有效地参与了针对年轻人的当前性别特定组合预防艾滋病毒的预防研究，该研究将利用该研究。我们提出了一个实施科学框架，以解决HIV预防和治疗连续性，该框架将为您确定高需求的年轻妇女，提供测试方案以及预防初级HIV以及与SSA的HIV Care之间的最佳实践。目标1：我们建议在肯尼亚Nyanza确定15-24岁的艾滋病毒风险，在过去六个月内没有进行HIV测试，利用1）基于社区（N≥500）和2）（n≥500）（N≥500）“寻求”策略，并比较HIV测试的吸收和预期（产量）。逻辑回归分析将确定哪种招聘策略产生了更高的新诊断的HIV感染率。将提供注册的年轻妇女（n≥1,000）1）HIV口服液体自我测试（OST），2）员工辅助测试（HTC）和3）基于标准的提供者/基于功能的测试，以确定该人群对基于吸收模式的HIV验证服务的位置和模态的偏好。多项式逻辑回归将用于了解女性青年首选哪种测试方法。 AIM 2：我们将试行并评估适应性干预（“智能”试验），以将HIV阳性女性青年（预期n = 100）与HIV治疗联系起来。我们将随机将参与者接收文本消息/SMS或标准推荐；那些不链接到护理的人将被重新融合以接收1）一次性的经济激励措施与Care vs. 2）SMS提醒。我们还将使用SMS平台向建议的6个月的艾滋病毒重新测试以及降低风险降低的艾滋病毒负面态度传递有针对性的消息，以支持预防高影响力。我们将重新测试这些HIV阴性的随机子集（n = 100），以记录12个月的HIV状态，并对基线和随访之间的HIV测试和预防服务访问进行调查。目标3：我们将使用成本效益和成本效益分析进行经济评估，以确定目标1-2寻求，测试，链接和预防干预措施的相对效用。我们将与肯尼亚政府分享研究结果，以告知设计其计划中的国家电子艾滋病毒SMS系统，更强大的国家对艾滋病毒自我测试的推出，并增强对最脆弱的年轻妇女的高影响力的艾滋病毒预防和治疗。