Interrupting HIV and TB stigma in the household during TB contact investigation in Uganda

项目摘要/摘要 随着人们普遍获得高质量的艾滋病毒治疗，对艾滋病毒状况的认识仍然是最多的 撒哈拉以南非洲公共卫生控制艾滋病毒的重要障碍，特别是在主要人群中 包括青少年、男性和结核病患者的密切接触者。由非专业卫生工作者进行的家庭测试提供了 这是一种行之有效的接触这类人群的方法，但测试接受率仍然低得令人无法接受。柱头 与艾滋病毒和结核病有关的疾病导致低摄取率，并可能因 家庭层面。关于群体背景下的个人决策的行为科学研究一个世纪 强烈建议优化测试邀请的顺序，将测试确立为规范的选择， 将测试作为一种亲社会行为，并提供一种侵入性较小的测试，可能会减少耻辱并提高对 测试。因此，这项申请提出了一系列初步的、前瞻性的、混合方法的研究 结核病患者家庭成员和业外保健员进行常规家庭接触调查 乌干达坎帕拉的结核病和艾滋病毒。这些研究的总体目标将是评估可行性， 减少污名和促进的复杂行为干预的可接受性和初步有效性 结核病患者家庭成员的HIV检测感染情况。创新的测试策略包括三个方面 组件，1)测试邀请的接受优化排序，2)亲社会消息，以及3)口头HIV 测试。在目标1中，将基于序列对新的测试邀请策略进行评估和迭代求精 与卫生工作者和家庭接触者收集定性数据，以及对 使用验证污名量表的接触者，根据其对家庭中结核病和艾滋病毒特异性污名的效用而被选择 水平。在目标2中，将对该策略进行前瞻性评估，以评估其对耻辱和测试摄取的影响。 实施方案设计。一个多学科的研究团队包括结核病-艾滋病毒病例发现方面的专家，社会 与公共卫生官员密切合作的科学和实施研究；他们还 在实施科学方面建设地方研究能力的经验。预期的影响是产生 关于提供家庭检测的新方法的初步数据，这种方法减少了家庭中分层的艾滋病毒-结核病污名， 以及它对检测、与护理的联系和保留的影响，建立在强大的科学前提下 关于社会决策的长期研究。该项目还将通过支持一个 项目团队中的当地博士生，并赞助关于艾滋病毒-结核病污名的年度科学研讨会 Makerere大学，目标是让广泛的利益攸关方参与推动当地研究议程 在这片区域。这些数据将为未来的随机研究提供信息，评估这些创新技术的临床影响 减少耻辱的方法，在家庭环境中提供和提供结核病和艾滋病毒咨询和检测。

PROJECT SUMMARY/ABSTRACT With widespread access to high-quality HIV treatment, awareness of HIV status remains among the most important barriers to public health control of HIV in sub-Saharan Africa, especially among key populations including adolescents, men, and close contacts of TB patients. Household testing by lay health workers offers a proven approach for reaching such populations, but rates of test acceptance remain unacceptably low. Stigma related to both HIV and TB contribute to low uptake, and may be reinforced by social interactions at the household level. A century of behavioral science research on individual decision-making in group contexts strongly suggests that optimizing the order of test invitations to establish testing as the normative choice, framing testing as a prosocial behavior, and offering a less invasive test is likely to reduce stigma and improve uptake of testing. Therefore, this application proposes a series of preliminary, prospective, mixed-methods studies with household members of TB patients and lay health workers delivering routine household contact investigation for TB and HIV in Kampala, Uganda. The overall objective of these studies will be to evaluate the feasibility, acceptability, and preliminary effectiveness of a complex behavioral intervention to reduce stigma and promote HIV testing uptake among household members of TB patients. The innovative testing strategy includes three components, 1) acceptance-optimized sequencing of test invitations, 2) prosocial messaging, and 3) oral HIV testing. In Aim 1, the novel test invitation strategy will be evaluated and iteratively refined based on serial qualitative data collection with health workers and household contacts, as well as before-and-after surveys of contacts using validated stigma scales selected for their utility for TB- and HIV-specific stigma at the household level. In Aim 2, the strategy will be prospectively evaluated for its effects on stigma and test uptake in a pre-post implementation design. A multi-disciplinary research team includes experts in case-finding for TB-HIV, social sciences, and implementation research working in close partnership with public health officials; they also have experience in building local research capacity in implementation science. The expected impact is to generate preliminary data on a novel approach to offering home testing that reduces layered HIV-TB stigma in households, and on its effects on testing and linkage to and retention in care, built on the strong scientific premise of longstanding research on social decision-making. The project will also enhance local capacity by supporting a local doctoral student on the project team and sponsoring annual scientific symposia on HIV-TB stigma at Makerere University, with the goal of engaging a broad group of stakeholders to advance a local research agenda in this area. These data will inform a future randomized study evaluating the clinical impact of these innovative stigma-reducing approaches to offering and delivering TB and HIV counseling and testing in household settings.