Family-Based HIV VCT in Patients at Risk for TB

描述（由申请人提供）：全球呼吁在撒哈拉以南非洲迅速采用艾滋病毒抗逆转录病毒疗法，迫切需要改进对艾滋病毒感染者的识别，并成功地与艾滋病毒医疗保健和社会支助联系起来。艾滋病毒自愿咨询和检测（VCT）已被证明在帮助个人了解他们的艾滋病毒状况和获得护理方面是有效的。结核病患者是VCT识别艾滋病毒感染并将个体与艾滋病毒特异性护理联系起来的最大机会之一。在发展中国家，艾滋病毒流行与先前存在的结核病流行有很大重叠，新诊断的结核病患者中艾滋病毒流行率超过50%。与一般人群相比，结核病患者的家庭成员，特别是配偶和年幼子女的艾滋病毒感染率也大大提高。然而，所有这些组的VCT使用率都很低（<10%）。我们建议测试一项干预措施的有效性，该干预措施利用艾滋病毒快速检测并将艾滋病毒VCT整合到结核病评估和家庭成员的家庭VCT中，以克服新发结核病患者艾滋病毒及其家庭成员对艾滋病毒VCT的确定的后勤和心理障碍。研究的具体目的是：1)在乌干达坎帕拉老穆拉戈医院的乌干达国家结核病和麻风病规划结核病门诊诊所，对2000名提供当日艾滋病毒咨询和检测结果的结核病评估患者进行横断面抽样，以确定VCT的吸收情况和障碍。2)在600个家庭中进行艾滋病毒VCT的随机试验，比较家庭VCT和结核病评估患者家庭成员基于家庭和基于结核病诊所的VCT的吸收情况。3)探讨以家庭为基础和以结核病诊所为基础的VCT在将600个随机家庭中的艾滋病毒感染者与艾滋病毒医疗保健和社会支持联系起来的效果。

DESCRIPTION (provided by applicant): The global call for the rapid introduction of HIV antiretroviral therapy to sub-Saharan Africa urgently requires improved identification of HIV infected persons and successful linkage to HIV medical care and social support. Voluntary Counseling and Testing (VCT) for HIV has been shown to be effective in helping individuals learn their HIV status and get into care. Tuberculosis (TB) patients present one of the greatest opportunities for VCT to identify HIV infections and link individuals into HIV specific care. In the developing world, the HIV epidemic overlaps significantly with pre-existing epidemics of TB and the HIV prevalence among individuals newly diagnosed with TB is greater than 50%. Family and household members of TB patients, especially spouses and young children, also have a greatly elevated prevalence of HIV infection compared to that of the general population. However, VCT use among all these groups is low (<10%). We propose to test the efficacy of an intervention utilizing HIV rapid testing and integration of HIV VCT into TB evaluation and home-based VCT for family members, to overcome identified logistical and psychological barriers to HIV VCT among new TB patients HIV and their family members. The specific aims of the study are: 1) To determine the uptake of and barriers to VCT among a cross-sectional sample of 2,000 TB evaluation patients offered same-day results HIV counseling and testing at the Uganda National TB and , Leprosy Programme outpatient TB clinic at Old Mulago Hospital in Kampala, Uganda. 2) To conduct a randomized trial of HIV VCT among 600 households comparing VCT uptake between Home-based VCT and TB Clinic-based VCT for family and household members of TB evaluation patients. 3) To investigate the effectiveness of Home-based and TB Clinic-based VCT in linking HIV infected persons among the 600 randomized households to HIV medical care and social support.