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

 描述(由申请人提供)：撒哈拉以南非洲(SSA)的艾滋病毒流行率是全球任何地区中最高的，SSA的女性风险最高。在肯尼亚，除西部(Nyanza)外，成人艾滋病毒流行率在全国范围内都有所下降。肯尼亚15-24岁青年的艾滋病毒发病率在2007-12年间没有变化，这表明迫切需要更多创新和有效的艾滋病毒预防和治疗。在肯尼亚，15-24岁的女性感染艾滋病毒的可能性是男性的2-3倍。青少年怀孕的相关风险导致垂直艾滋病毒。在这些流行病风险与有针对性地为年轻妇女提供有效干预以获得检测、预防或与艾滋病毒治疗挂钩之间存在着巨大的差距。我们的科学团队包括研究人员、实施者和卫生部，正在卓有成效地参与当前针对青年的性别组合艾滋病毒预防研究，拟议的工作将利用这项研究。我们提出了一个实施科学框架，以解决艾滋病毒预防和治疗的连续体问题，该框架将为识别高需要的年轻妇女、提供检测选择、艾滋病毒初级预防以及与艾滋病毒护理的联系方面的最佳做法提供信息。目的1：我们建议利用1)基于社区(n≥500)和2)基于家庭(n≥500)的‘Seek’策略，识别肯尼亚年扎15-24岁有艾滋病毒风险的女性，她们在过去六个月内没有接受艾滋病毒检测，并比较艾滋病毒检测的摄取率和流行率(收益率)。Logistic回归分析将确定哪种招募策略会产生更高的新诊断艾滋病毒感染率。将向登记的年轻女性(n≥1,000)提供1)艾滋病毒口腔液自我检测、2)工作人员辅助检测和3)标准提供者/设施检测，以根据感染模式确定这一人群对艾滋病毒检测服务的地点和方式的偏好。多项Logistic回归将被用来了解年轻女性更喜欢哪些测试方法。目标2：我们将试行和评估一项适应性干预(“SMART”试验)，将HIV阳性的女青年(预计n=100)与HIV治疗联系起来。我们将随机安排参与者接受短信/短信或标准转介；那些没有链接到护理的参与者将被重新随机，以获得1)链接到护理的一次性经济激励与2)短信提醒。我们还将利用短信平台，围绕建议的6个月HIV复检和降低风险行为，向高危HIV阴性者传递有针对性的信息，以支持高影响力的预防。我们将重新测试这些HIV阴性的随机子集(n=100)，以记录12个月后的HIV状况，并在基线和后续期间调查他们关于HIV检测和预防服务获得的情况。目标3：我们将利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，为其规划的国家艾滋病毒电子短信系统的设计提供信息，加强全国艾滋病毒自我检测的推广，并加强对最脆弱年轻女性的高影响力艾滋病毒预防和治疗。

 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.