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

项目摘要/摘要 由于以艾滋病毒为中心的服务的耻辱，在社区环境中，艾滋病毒检测往往被回避。我们最新的试飞 研究强烈建议整合包括艾滋病毒、糖尿病和高血压在内一揽子筛查 承诺大幅增加艾滋病毒检测的接受率，同时提供急需的 社区筛查糖尿病和高血压等非传染性疾病(NCDs) 在撒哈拉以南非洲，它们自身也处于流行水平。在我们的初步研究中，我们发现艾滋病毒检测几乎 当加入糖尿病和高血压筛查后，这一比例翻了一番。此外，一旦感染艾滋病毒的个人 由于以艾滋病毒为中心的护理项目的耻辱，随着时间的推移，许多人不愿进入护理机构 客户的流失是一个严重的问题，破坏了这些计划的临床和公共卫生利益。 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会增加 登记和保留艾滋病毒护理，为所有参与者消除诊所的歧视，并提供切实的 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，特别是那些正在等待的人 成为有资格参加ART的人，他们也是那些流失率最高的人。我们将评估：(A)客户 基萨拉韦地区6个艾滋病毒护理和治疗中心(CTC)的使用特点和模式， 坦桑尼亚；(B)艾滋病毒检测趋势；(C)艾滋病毒干预历史(D)人口普查数据；(E)开展社区活动 在每个反恐中心的集水区绘制地图；(F)与社区领袖和医务人员协商；和(G) 匹配两个相似的CTC。下一步，两个CTC中的一个将被随机作为强化干预地点。在… 我们将对两个社区中心进行社区动员，提醒社区注意可用的服务。在增强版中 干预CTC我们还将提供糖尿病和高血压的筛查。健康中心(始终 将协助治疗非传染性疾病阳性病例。将转介感染艾滋病毒的客户 两个地点的CTC，以及每个CTC的前89名患者将被纳入队列，并进行24- 月(2个诊所的N=178)。加强干预CTC队列中的非传染性疾病 积极的人会将对非传染性疾病的关怀与他们的艾滋病毒护理结合起来。我们将评估非传染性疾病筛查如何影响 在大约18个月的时间里在社区一级接受艾滋病毒检测。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情况。我们将确定是否在新的艾滋病毒护理中保留 通过增加非传染性疾病护理，注册客户在24个月内得到增强。然后我们将付出一切干预的代价 确定每个新增的艾滋病毒检测客户、参加艾滋病毒护理的客户的增量成本的组件，以及 通过增加非传染性疾病筛查和护理，保留在艾滋病毒护理中。

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.