An investigation of interventions to increase uptake of HIV self-testing and linkage to post-test services among higher education students in Zimbabwe

在全球青少年和青年中，非洲青少年和青年的健康状况最差，这在很大程度上是因为艾滋病毒新感染率高，特别是在青年妇女中。尽管如此，年轻人比老年人更不可能了解自己的艾滋病毒状况，因此也更不可能从预防和治疗方案中受益。未来30年，非洲青年人口将翻一番，这意味着如果不采取任何措施改善青年人获得艾滋病毒预防和护理的机会，青年人新感染的人数也将翻一番。该项目以高等教育机构的青年学生为对象，采用一种新的干预措施-艾滋病毒自我检测，旨在提高他们对艾滋病毒检测的接受程度，并支持他们接受预防和护理服务。艾滋病毒自我检测，即人们检测自己是否感染艾滋病毒，已被证明是安全和准确的，在这里非常重要，对于那些希望在检测时拥有隐私和自主权的年轻人来说，这是非常可以接受的。我建议比较的有效性和成本和成本效益的两种模式，分发艾滋病毒自我检测的学生，在试验中，高等教育机构被随机分配到两个分配模式之一。成果包括：㈠自我检测的采用，㈡根据艾滋病毒结果与艾滋病毒预防和护理服务的联系，㈢检测、诊断为阳性并开始接受治疗或预防服务的人均费用。要比较的两种艾滋病毒自我检测分布模式是同伴主导加大众媒体支持的模式和仅大众媒体模式。我还将开发一个基于互联网的工具，以衡量自我检测试剂盒的分发情况，并支持和衡量随后的服务参与情况。然后，我将探讨如何使这些年轻人的自我测试模型适应其他环境（如学校或工作场所），并支持预防和护理年轻人的其他慢性病（如高血压或精神健康状况不佳）。

Adolescents and young people in Africa have the worst health outcomes of adolescents and young people globally, in large part because of the high rate of new HIV infections, particularly among young women. Despite this, young people are less likely to know their HIV status than older adults and as such are less likely to benefit from prevention and treatment options. The population of young Africans is set to double in the next 30 years meaning that if nothing is done to improve young people's access to HIV prevention and care, the number of new infections in young people will also double. This project targets young students attending higher education institutions with a novel intervention, HIV self-testing, aimed at improving their uptake of HIV testing and supporting them to take up prevention and care services. HIV self-testing, where people test themselves for HIV infection, has been shown to be safe and accurate and of importance here, highly acceptable to young people who desire privacy and autonomy when testing. I propose to compare the effectiveness and cost and cost effectiveness of two models of distributing HIV self-testing among students, in a trial where higher education institutions are allocated by chance to one of two distribution models. Outcomes include: i) uptake of self-testing, ii) linkage to HIV prevention and care services depending on their HIV result and, iii) cost per person tested, diagnosed positive and started on treatment or preventive service. The two HIV self-test distribution models to be compared are a peer-led plus mass-media supported model with a mass media only model. I will also develop an internet based tool to measure distribution of self-test kits and support and measure subsequent engagement with services. I will then explore how to adapt these self-testing models for young people to other settings (eg schools or workplaces) and to support prevention and care for other chronic diseases in young people (eg hypertension or poor mental health).