HIV self-testing and PrEP to increase testing and prevention uptake among male partners and improve postpartum ART use in PMTCT B+ programs in Uganda

摘要 乌干达的艾滋病毒负担在全球排名第五，是非洲生育率最高的国家之一。预防 母婴传播方案B+(母婴传播B+)是乌干达的国策。为了最大限度地预防 预防母婴传播B+的临床益处，男性伴侣低艾滋病毒检测的挑战，以及高产后感染率 产期停止抗逆转录病毒治疗(ART)，ART依从性不足，病毒感染不完全 需要解决压制问题。女性可能更有可能长期接受艺术治疗，并拥有更高的 产后坚持如果他们的伴侣进行了检测，就有相互披露的艾滋病毒状况，而他们的伴侣 接受ART或PrEP，取决于合作伙伴的状态。需要创新的方法来允许男性进行测试 在繁忙的产前诊所的替代环境中，最好是私下进行，让他们感到舒服，不会错过 工作。我们将使用创新技术-艾滋病毒自我检测(HIVST)和暴露前预防(PrEP)- 增加男性伴侣对艾滋病毒检测、预防和护理服务的参与度。我们将对孕妇进行培训 在使用和解释HIVST时，向他们提供两个口服液HIVST试剂盒，供他们使用或给予 他们的搭档。我们将为男性提供验证性测试、咨询，如果阴性，我们将提供PrEP，如果阳性，我们将提供ART。我们 将提供咨询，将艾滋病毒自我检测的社会危害降至最低。为艾滋病毒阴性的男性伴侣做好准备- 阳性孕妇在重要的“危险季节”期间提供有效的干预，当她们可能 通过其他伴侣或当他们的伴侣可能是病毒携带者时(在之后的头几个月)有额外的风险 ART启动、产后ART停止或由于病毒抵抗)..集成PrEP和ART交付 在东非HIV血清不一致的夫妇中，PrEP作为一座桥梁，直到HIV阳性的伴侣 接受抗逆转录病毒治疗六个月是非常可以接受的，达到了非常高的接受度和对抗逆转录病毒药物和PrEP的坚持， 并几乎消除了艾滋病毒的传播。我们将使用HIVST来识别HIV血清不一致的夫妇，并适应 PrEP与乌干达PMTCT B+方案的衔接策略，以增加产后ART的延续 临床和预防方面的好处。目标1：确定乌干达加强的防止母婴传播方案是否 为男性伴侣提供艾滋病毒自我检测，为艾滋病毒阴性男性提供PrEP增加 检测艾滋病毒并启动PrEP的男性。目标2：评估艾滋病毒检测和PrEP和ART的使用情况 在乌干达感染艾滋病毒的妇女中，男性伴侣增加了产后有效的ART使用 PMTCT B+。目的3：评估母婴传播中孕妇对HIV自我检测和PrEP的可接受性 B+及其男性伴侣，使用定性和定量方法。总而言之，这个项目将 通过评估增加男性伴侣的创新战略，解决预防母婴传播B+项目中的关键挑战 参与预防母婴传播B-HIVST，以克服男性不愿测试和他们倾向于“通过代理”测试， 此外，还向艾滋病毒阴性男子提供PrEP，向艾滋病毒阳性男子提供ART，并鼓励产后ART 在艾滋病毒阳性妇女中的延续和坚持。

ABSTRACT Uganda has the fifth highest HIV burden globally and one of the highest fertility rates in Africa. Prevention of mother-to-child transmission Option B+ (PMTCT B+) is national policy in Uganda. To maximize the prevention and clinical benefits of PMTCT B+, the challenges of low HIV testing by male partners and high rates of post- partum discontinuation of antiretroviral therapy (ART), insufficient ART adherence, and incomplete viral suppression need to be addressed. Women may be more likely to continue ART long-term and have higher adherence post-partum if their partners are tested, there is mutual disclosure of HIV status, and their partner takes ART or PrEP, depending on the partner’s status. Innovative approaches are needed to allow men to test in alternative settings to busy antenatal clinics, preferably privately where they are comfortable and do not miss work. We will use innovative technologies – HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP) – to increase male partners’ engagement in HIV testing, prevention, and care services. We will train pregnant women in the use and interpretation of HIVST, provide them with two oral fluid-based HIVST kits to use with or give to their partners. We will offer men confirmatory testing, counseling, and if negative, PrEP and if positive, ART. We will provide counseling to minimize social harms of HIV self-testing. PrEP for HIV-negative male partners of HIV- positive pregnant women provides an effective intervention during an important ‘season of risk’ when they may have additional risk through other partners or when their partner may be viremic (during the first few months after ART initiation, post-partum ART discontinuation or due to viral resistance).. Integrated PrEP and ART delivery among East African HIV serodiscordant couples showed that PrEP as a ‘bridge’ until the HIV-positive partner was on ART for six months was very acceptable, achieved very high uptake and adherence to ART and PrEP, and nearly eliminated HIV transmission. We will use HIVST to identify HIV serodiscordant couples, and adapt the PrEP bridging strategy to Ugandan PMTCT B+ programs to increase ART continuation post-partum for clinical and prevention benefits. Aim 1: Determine whether an enhanced PMTCT program in Uganda that provides HIV self-testing for male partners and PrEP for HIV-negative men increases the proportion of men who test for HIV and initiate PrEP. Aim 2: Evaluate whether HIV testing and PrEP and ART use among male partners increases effective post-partum ART use among HIV-infected Ugandan women in PMTCT B+. Aim 3: Assess the acceptability of HIV self-testing and PrEP to pregnant women in PMTCT B+ and to their male partners, using qualitative and quantitative methods. In summary, this project will address key challenges in PMTCT B+ programs, by evaluating innovative strategies to increase male partner involvement in PMTCT B – HIVST to overcome men’s reluctance to test and their tendency to test ‘by proxy,’ coupled with offering PrEP to HIV-negative men, ART to HIV-positive men, and encouraging post-partum ART continuation and adherence among HIV-positive women.