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最高的，SSA的女性风险最高。在肯尼亚，除西部（尼扬扎）外，全国成年人艾滋病毒流行率都有所下降。2007年至2012年期间，肯尼亚15至24岁青年的艾滋病毒发病率没有变化，这表明迫切需要更创新和有效的艾滋病毒预防和治疗。在肯尼亚，15至24岁的妇女感染艾滋病毒的可能性比男性高2至3倍。少女怀孕的相关风险会导致纵向艾滋病毒感染。这些流行病风险与有针对性地为年轻妇女提供有效干预措施以获得检测、预防或与艾滋病毒治疗挂钩之间存在巨大差距。我们的科学团队包括研究人员、执行人员和卫生部，正在富有成效地参与一项针对青年的针对性别的艾滋病毒预防综合研究，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性，这将为确定高度需要的年轻妇女，提供检测选择，初级艾滋病毒预防以及与艾滋病毒护理的联系提供最佳做法。目标1：我们建议在肯尼亚的尼扬扎确定15-24岁的女性青年，在过去的六个月内没有进行艾滋病毒检测，利用1）基于社区（n≥500）和2）基于家庭（n≥500）的“寻求”策略，并比较艾滋病毒检测的吸收和流行率（产量）。逻辑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。将为入组的年轻女性（n≥ 1，000）提供1）艾滋病毒口服液自我检测（OST），2）工作人员辅助检测（HTC）和3）标准提供者/机构检测，以根据摄取模式确定该人群对艾滋病毒检测服务的地点和方式的偏好。多元逻辑回归将用于了解哪些测试方法是首选的女性青年。目标2：我们将试点和评估适应性干预措施（“SMART”试验），将艾滋病毒阳性女青年（预计n=100）与艾滋病毒治疗联系起来。我们将随机分配受试者以接收短信/SMS或标准转诊;未链接到护理的受试者将重新随机分配，以接收1）链接到护理的一次性财务激励vs. 2）SMS提醒。我们还将利用短信平台，向高风险艾滋病毒阴性者提供有关建议的6个月艾滋病毒复检和降低风险行为的有针对性的信息，以支持高影响力的预防。我们将重新测试这些HIV阴性者的随机子集（n=100），以记录12个月时的HIV状态，并调查他们在基线和随访之间的HIV检测和预防服务获得情况。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中每一项寻求、测试、联系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，为他们计划的国家艾滋病毒电子短信系统的设计提供信息，加强艾滋病毒自我检测的国家推广，并加强对最脆弱的年轻妇女的高效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.