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

项目总结/摘要 随着高质量艾滋病毒治疗的普及，对艾滋病毒状况的认识仍然是最重要的因素之一。 在撒哈拉以南非洲，特别是在重点人群中，艾滋病毒公共卫生控制的重要障碍 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检测提供了一种 目前，已经有一种行之有效的方法可以接触到这些人群，但测试接受率仍然低得令人无法接受。耻辱 与艾滋病毒和结核病有关的疾病导致了低吸收率，并可能通过社会互动得到加强。 家庭层面。群体背景下个人决策行为科学研究的一个世纪 强烈建议，优化测试邀请的顺序，以建立测试作为规范的选择，框架， 测试作为一种亲社会行为，并提供一个侵入性较小的测试可能会减少耻辱和提高吸收 试验.因此，本申请提出了一系列初步、前瞻性、混合方法研究， 结核病患者家庭成员和非专业卫生工作者进行例行家庭接触调查， 乌干达坎帕拉的结核病和艾滋病毒。这些研究的总体目标是评估可行性， 的可接受性和初步有效性，以减少耻辱和促进 结核病患者家庭成员接受艾滋病毒检测的情况。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）亲社会消息传递，以及3）口头艾滋病毒 试验.在目标1中，新的测试邀请策略将被评估，并基于序列迭代地改进。 与卫生工作者和家庭接触者的定性数据收集，以及 接触者使用经验证的污名量表，选择这些量表用于家庭中结核病和艾滋病毒特异性污名 水平在目标2中，将前瞻性地评估该策略对前后测试中的耻辱感和测试吸收的影响。 实施设计。一个多学科的研究小组，包括结核病-艾滋病毒病例发现专家，社会 科学和实施研究与公共卫生官员密切合作;他们还 在执行科学方面建设当地研究能力的经验。预期的影响是产生 提供家庭检测新方法的初步数据，该方法减少了家庭中对艾滋病毒-结核病的分层歧视， 及其对检测以及与护理的联系和保留的影响，建立在以下强有力的科学前提之上： 对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，并赞助了关于艾滋病毒结核病耻辱的年度科学研讨会， Makerere大学，目标是让广泛的利益相关者参与推进当地的研究议程 在这个领域。这些数据将为未来的随机研究提供信息，以评估这些创新药物的临床影响。 在家庭环境中提供和实施结核病和艾滋病毒咨询和检测的减少耻辱的方法。

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.