Impact of Integrated HIV/NCD Screening on HIV Testing Uptake and Engagement in HIV Care: an RCT in Kisarawe, Tanzania

项目总结/摘要 由于以艾滋病毒为中心的服务的耻辱感，艾滋病毒检测往往在社区环境中被回避。我们最近的飞行员 研究强烈建议将包括艾滋病毒、糖尿病和高血压在内一揽子筛查结合起来 承诺大幅增加艾滋病毒检测的使用，同时提供迫切需要的 社区筛查糖尿病和高血压等非传染性疾病， 在撒哈拉以南的非洲地区也处于流行水平。在我们的试点研究中，我们发现艾滋病毒检测几乎 增加了糖尿病和高血压筛查后增加了一倍。此外，一旦艾滋病毒感染者 由于以艾滋病毒为中心的护理计划的耻辱感，许多人不愿意进入护理，随着时间的推移， 客户流失是一个严重的问题，损害了这些方案的临床和公共卫生效益。 我们的初步研究强烈表明，将非传染性疾病护理纳入艾滋病毒护理将增加 通过消除诊所对所有参加者的污名化，并通过提供有形的 为估计79%同时患有非传染性疾病的艾滋病毒感染者提供临床治疗，特别是那些等待治疗的人 有资格接受抗逆转录病毒治疗，他们也是自然减员最多的人。我们将评估：（a）客户 基萨拉韦县6个艾滋病毒护理和治疗中心的使用特点和模式， 坦桑尼亚;（B）艾滋病毒检测的趋势;（c）艾滋病毒干预的历史;（d）普查数据;（e）社区行为 （f）与社区领袖和医务人员协商，以及（g） 匹配两个相似的CTC接下来，两个CTC中的一个将被随机分配为增强干预部位。在 我们会在这两个社区中心进行社区动员，提醒社区注意可提供的服务。在增强 干预CTC我们还将提供糖尿病和高血压筛查。健康中心（Always） 中心附近）将协助治疗非传染性疾病阳性病例。艾滋病毒感染者将被转介到 两个研究中心的CTC，每个CTC的前89例患者将入组一个队列，并随访24- 月（2家诊所共计N=178）。强化干预CTC队列中的NCD患者 艾滋病毒感染者将把非传染性疾病护理与艾滋病毒护理结合起来。我们将评估NCD筛查如何影响 在大约18个月的时间里，在社区一级进行艾滋病毒检测。我们将确定是否将NCD护理添加到 艾滋病毒护理改善了艾滋病毒护理的联系和登记。我们将确定是否保留在艾滋病毒护理的新 通过增加非传染性疾病护理，在24个月内加强了登记的客户。然后我们将花费所有的干预 确定每增加一个接受艾滋病毒检测、登记接受艾滋病毒护理的客户的增量成本的组成部分，以及 通过增加非传染性疾病筛查和护理来保留艾滋病毒护理。

PROJECT SUMMARY / ABSTRACT HIV testing is often shunned in community settings due to the stigma of HIV-centric services. Our recent pilot study strongly suggest that integration of a package of screening that include HIV, diabetes, and hypertension hold promise of substantially increasing the uptake of HIV testing while simultaneously providing direly needed community screening for non-communicable disease (NCDs) like diabetes and hypertension, which themselves are at epidemic levels in Sub-Saharan Africa. In our pilot study we found that HIV testing almost doubled when diabetes and hypertension screening was added. Moreover, once HIV-infected individuals are identified, many are reluctant to enter care due to the stigma of HIV-centric care programs, and over time attrition of clients is a serious problem undermining the clinical and public health benefits of these programs. Our preliminary studies strongly suggest that integration of NCD care within HIV care would increase enrollment and retention in HIV care by destigmatizing the clinics for all attendees, and by providing tangible clinical therapies for the estimated 79% of HIV-infected clients who also have NCDs, especially those waiting to become eligible for ART, who are also those with the highest attrition. We will assess: (a) the client characteristics and patterns of utilization at the 6 HIV Care and Treatment Centers (CTCs) in Kisarawe District, Tanzania; (b) trends in HIV testing; (c) history of HIV intervention (d) census data; (e) conduct community mapping in each CTC’s catchment area; (f) consult with community leaders and Medical Officers , and (g) match two similar CTCs . Next, one of the two CTCs will be randomized as an enhanced intervention site. At both CTCs we will conduct community mobilization to alert community of available services. At the enhanced intervention CTC we will also provide screening for diabetes and hypertension. The Health Center (always adjacent to the CTC) will be assisted with treating positive NCD cases. HIV-infected clients will be referred to the CTC at both sites, and the first 89 patients at each CTC will be enrolled in a cohort and followed for 24- months (total N=178 across 2 clinics). Those in the cohort at the enhanced intervention CTC who are NCD positive will have care for NCDs integrated with their HIV care. We will assess how NCD screening affects uptake of HIV testing at the community-level over ~18-months. We will establish whether adding NCD care to HIV care improves linkage and enrollment in HIV care. We will determine if retention in HIV care among newly enrolled clients is enhanced over 24-months with the addition of NCD care. We will then cost all intervention components to determine the incremental cost per added client tested for HIV, enrolled in HIV care, and retained in HIV care by adding NCD screening and care.