Translating Oral-HIV Testing to Low Income, Low Literacy Youth in Tanzania

 描述(由申请人提供)：在检测和治疗艾滋病毒预防中，艾滋病毒检测和与护理挂钩(LTC)是关键步骤。然而，在低收入的撒哈拉以南非洲国家，有许多服务不足的地区，艾滋病毒检测和长期监禁的机会很低。坦桑尼亚是艾滋病毒感染率高、普遍流行、获得护理的机会低、人口众多、贫困和受教育程度有限的国家之一。坦桑尼亚青少年面临以诊所为基础的检测机会有限和长期培训制度不足的问题。如果翻译得当，口腔自行实施的艾滋病毒检测(ORTLE-SIT)可能会为增加对低收入青年的艾滋病毒检测服务和支持长期培训提供一种可行的替代方案。低收入、低识字率、低技术水平的人群尚未获得口述-坐姿工具包。此外，识字者和识字率低的人在正确执行口试程序(高保真)方面都面临挑战。总的来说，低收入、低文化、低技术 各国在实施新的公共卫生技术方面面临重大挑战。利用翻译框架，拟议的研究建立在以前在坦桑尼亚进行的试点研究的基础上，以审查培训青年以高保真自我实施口试的低技术、低识字率的方法，并扩展先前关于坦桑尼亚城市青年之间的联系与护理的工作。我们比较了两种培训青少年(15-19岁；N=286)使用口腔训练的方法，并增加了他们对接受治疗的重要性的理解：(A)一种使用低成本、低识字率、低技术的图画指导书(PIB)；(B)一种使用简短的视频来加强年轻人对PIB的理解。口腔-坐位表现，以及寻求确证测试和治疗的意图将被检查。执行失败或成功的一个重要步骤是了解参与者如何理解执行说明。因此，我们还评估了参与者对教学材料的理解程度。虽然如建议的那样增加视频交付的社会成本更高，但如果视频培训主要发生在组织层面，这种方法是可持续的。也就是说，一旦消费者通过视频接受了使用PIB的培训，我们预计仅PIB一项就足以维持未来使用口腔-SIT的高保真度。这项适当的研究为进一步评估口腔坐着能力的随机现场试验奠定了基础， 如果使用得当，将增加艾滋病毒病例的确认率，使其超过目前通过临床检测获得的水平。这项研究提供了相当大的控制，这是通过活体研究无法实现的，而且该程序允许直接观察自我实施。建议的R01将通过扩展我们对自我实现保真度的前因的知识来增加翻译科学。这项研究的首要目标是通过口服艾滋病毒检测来解决自我实施的保真度问题，并以成本效益的方式增加艾滋病毒检测和LTC，旨在减少艾滋病毒的传播、发病率和死亡率。

 DESCRIPTION (provided by applicant): In test-and-treat HIV prevention, HIV testing and linkage-to-care (LTC) are pivotal steps. However in low- income Sub-Saharan African countries, there are many underserved areas with low access to HIV testing and LTC. Tanzania is among those countries with high HIV prevalence, a generalized epidemic, low access to care, and large population segments who are impoverished and have limited education. Adolescent Tanzanian youth are faced with limited clinic based testing opportunities and an inadequate LTC system. Oral self- implemented HIV testing (oral-SIT), if appropriately translated, may offer a viable alternative for increasing the reach of HIV testing services to low-income youth and support LTC. Oral-SIT kits have not been translated to low-income, low literacy, low technology populations. Moreover, both literate and low literacy persons have challenges with performing oral-SIT procedures correctly (high fidelity). In general, low-income, low literacy, low technology countries are faced with significant challenges to implementing new public health technology. Using a translation framework, the proposed research builds on previous pilot research conducted in Tanzania to examine low technology, low literacy methods of training youth to self-implement oral-SITs with high fidelity and extend prior work on linkage-to-care among urban Tanzanian youth. We compare two methods of training youth (15-19 yrs.; N = 286) to use oral-SITs and increase their understanding of the importance of receiving treatment: (a) one that uses a low cost, low literacy, low technology pictorial instruction book (PIB), and (b) one that employs a brief video to enhance youths' comprehension of the PIB. Oral-SIT performance, and intentions to seek confirmatory testing and treatment will be examined. An important step in implementation failure or success is in understanding how participants comprehend implementation instructions. Consequently, we also assess participants' comprehension of instruction materials. Although the addition of video delivery, as proposed, is societally more expensive, this approach is sustainable if video training occurs primarily at the organizational level. That is, once the consumer has been trained via video in the use of the PIB, we expect that the PIB alone will be sufficient to sustain high fidelity in future use of oral-SIT. The propoed study lays the groundwork for randomized field trials to further evaluate the ability of oral-SITs, when used correctly, to increase identification of HIV cases beyond levels currently obtained with clinic based testing. The study provides considerable control that would not be achievable through in vivo studies, and the procedures allow for direct observation of self-implementation. The proposed R01 will add to the science of translation by expanding our knowledge of the antecedents of self-implementation fidelity. The overarching goal of this study is to solve self-implementation fidelity problems with oral HIV testing and cost-efficiently increase HIV testing and LTC aimed at reducing HIV transmission, morbidity, and mortality.