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，艾滋病毒检测和护理联系（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，很少有机会获得艾滋病毒检测和长期护理。坦桑尼亚是艾滋病毒流行率高、普遍流行、获得护理的机会少、贫穷人口多、受教育程度低的国家之一。坦桑尼亚青少年面临着有限的诊所检测机会和不充分的LTC系统。自我实施的口服艾滋病毒检测（口服-SIT），如果翻译得当，可以提供一个可行的替代方案，增加艾滋病毒检测服务的覆盖面，以低收入青年和支持长期护理。口服SIT工具包尚未转化为低收入、低识字率、低技术人口。此外，识字和识字率低的人都面临着正确执行口头SIT程序（高保真）的挑战。一般来说，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。使用翻译框架，拟议的研究建立在以前的试点研究在坦桑尼亚进行检查低技术，低识字率的方法，培训青年自我实施口头SIT与高保真度和扩展之前的工作联系到照顾城市坦桑尼亚青年。我们比较了两种训练青少年（15-19岁; N = 286）使用口服SIT，并提高他们对接受治疗的重要性的理解：（a）使用低成本、低识字率、低技术的图形说明书（PI B），（B）采用简短的视频，以提高年轻人对PI B的理解。将检查口服SIT性能以及寻求确证性检测和治疗的意图。实施失败或成功的一个重要步骤是了解参与者如何理解实施指令。因此，我们也评估参与者对教学材料的理解。虽然所提议的增加视频传输的社会成本更高，但如果视频培训主要在组织一级进行，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PIB本身就足以在未来使用口服SIT时保持高保真度。这项研究为随机田间试验奠定了基础，以进一步评估口服SIT的能力， 如果使用得当，将提高艾滋病毒病例的识别率，超过目前诊所检测的水平。该研究提供了通过体内研究无法实现的相当大的控制，并且程序允许直接观察自我实现。建议R 01将增加科学的翻译，扩大我们的知识的前提下，自我实现的保真度。这项研究的总体目标是解决自我实现的保真度问题，口服艾滋病毒检测和成本效益增加艾滋病毒检测和长期护理，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.