Improving HIV testing, linkage, and retention in care for men through U=U messaging

项目摘要 增加艾滋病毒携带者(PLHIV)的艾滋病毒检测和治疗覆盖率对以下方面至关重要 结束全球艾滋病的流行。不幸的是，与女性相比，男性艾滋病毒携带者(MLHIV)较少 可能知道他们的艾滋病毒状况，开始抗逆转录病毒治疗，或实现病毒抑制。鉴于新的艾滋病毒 女性的感染在一定程度上是由男性的检测和治疗差距推动的，缩小了#年的性别差距 必须优先考虑测试男性对病毒的摄取、治疗启动和实现抑制病毒，以便 加快妇女艾滋病毒发病率的下降，改善男子与艾滋病毒有关的健康成果，并实现 联合国艾滋病规划署的目标是到2030年实现95-95-95年的目标。在这项研究中，我们评估了不可检测等号的有效性 无法传播或“U=U”的信息，用于缩小艾滋病毒级联中的性别差距。U=U消息 传播一种令人信服的想法，即接受抗逆转录病毒治疗并携带无法检测到的病毒载量的艾滋病病毒感染者(&lt；200 拷贝数/毫升)不会通过性传播艾滋病毒。尤其是对男性来说，U=U的信息有可能加速 在实现95-95-95目标方面取得进展：1)减少与艾滋病毒检测有关的焦虑(第95位)；2)令人鼓舞 艾滋病毒检测呈阳性的人开始抗逆转录病毒疗法(第2 95)；以及3)减少对将艾滋病毒传染给性伴侣的恐惧 通过促进治疗依从性来实现病毒抑制(第3 95)。虽然有越来越多的关于 治疗为预防(TasP)/U=U西方国家PLWH中U=U的覆盖范围和渗透率 撒哈拉以南非洲的信息有限，很少有研究测试可获得的U=U的影响 关于撒哈拉以南非洲地区接受和坚持抗逆转录病毒药物的信息。以我们之前关于U=U消息传递的工作为基础 在行为经济学和人本设计的启发下，我们建议进行两个混合类型1 有效性-实施随机对照试验以评估U=U消息对男性的影响 接受以社区为基础的艾滋病毒检测和治疗启动(目标1)，并实现病毒抑制 (目标2)。我们还将进行多方法评估，以告知未来U=U报文传送的实施情况 干预措施。为了提高研究结果的普适性，我们将在南方的两个省进行研究 非洲(西部和东开普省)。如果有效，我们的干预可以影响全球艾滋病毒检测和治疗 咨询指导方针和做法。我们的专家、多机构合作将使我们能够应用之前的 研究成果，利用独特的实施平台和资源，并迅速传播我们的 调查结果。

PROJECT ABSTRACT Increasing the coverage of HIV testing and treatment among people living with HIV (PLHIV) is essential for ending the global AIDS epidemic. Unfortunately, compared to women, men living with HIV (MLHIV) are less likely to know their HIV status, start anti-retroviral treatment, or achieve viral suppression. Given that new HIV infections among women are driven, in part, by men’s testing and treatment gaps, reducing the gender gap in testing uptake, treatment initiation and achievement of viral suppression by men must be prioritized in order to accelerate the decline in HIV incidence among women, improve men’s HIV-related health outcomes and achieve the UNAIDS 95-95-95 goals by 2030. In this study, we evaluate the effectiveness of Undetectable Equals Untransmittable or “U=U” messaging for closing the gender gap in the HIV cascade. The U=U message communicates the compelling idea that PLHIV who take ART and have an undetectable viral load (<200 copies/mL) cannot sexually transmit HIV. Particularly for men, the U=U message has the potential to accelerate progress towards the 95-95-95 targets by: 1) reducing anxiety associated with HIV testing (1st 95); 2) encouraging people who test HIV-positive to initiate ART (2nd 95); and 3) reducing fear of transmitting HIV to sexual partners by promoting treatment adherence to achieve viral suppression (3rd 95). While there is a growing knowledge of Treatment as Prevention (TasP)/U=U among PLWH in Western countries, the reach and penetration of the U=U message in sub-Saharan Africa has been limited and few studies have tested the impacted of accessible U=U messages on ART uptake and adherence in sub-Saharan Africa. Building on our prior work on U=U messaging informed by behavioral economics and human-centered design, we propose to conduct two hybrid type 1 effectiveness-implementation randomized controlled trials to evaluate the impact of U=U messages on men’s uptake of community-based HIV testing and treatment initiation (Aim 1), and achievement of viral suppression (Aim 2). We will also conduct a multi-method evaluation to inform future implementation of U=U messaging interventions. To improve the generalizability of our findings, we will conduct our study in two provinces in South Africa (Western and Eastern Cape). If effective, our intervention can shape global HIV testing and treatment counselling guidelines and practices. Our expert, multi-institutional collaborations will allow us to apply previous research findings, leverage unique implementation platforms and resources, and rapidly disseminate our findings.