HIV VCT and Linkage to Care in Uganda

描述（由申请人提供）：我们建议在一项随机对照试验中研究在常规艾滋病毒VCT （rVCT）背景下优化降低风险的策略，并将住院咨询和检测与出院后艾滋病毒医疗护理充分结合起来，以确保确诊的个体获得护理（包括必要时的抗逆转录病毒治疗）。我们将使用2 × 2因子设计来评估(a)两种HIV VCT模式和(b)两种与护理联系的策略的效果。这种高效的设计是在一项研究中测试多种干预措施的一种经济策略，我们的试点研究表明，我们可以在分配的时间内满足该设计要求的入组目标。在一项非劣效性研究设计中，第一项干预将比较住院常规咨询和检测（rVCT）与传统的艾滋病毒检测前和检测后咨询和检测（tVCT）。第二项干预措施将在优势设计中比较血清阳性患者的“加强与护理的联系”模式，以增加对艾滋病毒特异性医疗护理的吸收和长期利用，与通常转诊相比。本研究的主要具体目的是：具体目的1 (rVCT vs tVCT)：检验假设（非劣效性假设），即在住院成人中进行常规的艾滋病毒咨询和检测与传统的咨询和检测在减少出院后住院患者的艾滋病毒风险行为方面同样有效。具体目标2（加强联系vs.常规转诊）：检验假设（优势假设），即在接受艾滋病毒预防、抗逆转录病毒治疗和降低死亡率方面，披露后转诊到艾滋病毒特异性医疗护理的“加强联系”模式比常规转诊更有效。

DESCRIPTION (provided by applicant): We propose to examine in a randomized controlled trial strategies for optimizing risk reduction within the context of routine HIV VCT (rVCT) and fully integrating inpatient counseling and testing with post-discharge HIV medical care to ensure that diagnosed individuals receive access to care (including antiretroviral therapy if indicated). We will use a 2 x 2 factorial design to assess the effects of (a) two modes of HIV VCT and (b) two strategies for linkage to care. This highly efficient design is an economical strategy of testing multiple interventions in a single study, and our pilot studies demonstrate that we can meet enrollment targets required by this design within the allocated time period. The first intervention will compare, in a non-inferiority study design, in-patient routine counseling and testing (rVCT) with traditional HIV pre- and post-test counseling and testing (tVCT). The second intervention will compare, in a superiority design, an "enhanced linkage to care" model for seropositive persons to increase uptake and long-term utilization of HIV-specific medical care, compared to usual referral. The primary specific aims of the study are to: Specific Aim 1 (rVCT vs tVCT): Test the hypothesis (non-inferiority hypothesis) that routine counseling and testing for HIV among hospitalized adults is as efficacious as traditional counseling and testing in reducing HIV risk behavior among inpatients after discharge. Specific Aim 2 (Enhanced Linkage vs. Usual Referral): Test the hypothesis (superiority hypothesis) that an "enhanced linkage to care" model of post-disclosure referral to HIV-specific medical care is more effective than usual referral in receipt of Ol prophylaxis, ART, and reducing mortality.