Community-Based HIV VCT: Zimbabwe

描述(由申请人提供)：从公共卫生的角度来看，当今世界没有比发展中世界的艾滋病毒流行更令人信服的危机了。这是一项第三阶段的社区水平随机对照研究，其中非洲(坦桑尼亚、津巴布韦和南非)的32个社区和泰国的14个社区将随机接受基于社区的艾滋病毒自愿咨询和检测(CBVCT)干预或基于诊所的标准VCT(SVCT)。CBVCT干预有三个主要战略：(1)使VCT在社区环境中更容易获得；(2)通过外展使社区参与；(3)提供测试后支持。这三项战略旨在改变社区规范，降低所有社区成员感染艾滋病毒的风险，无论他们是否直接参与干预。因此，评估结果采用的是社区层面的抽样方法，而不是队列设计。 主要目的(目标1)是检验这样一种假设，即接受两年半CBVCT的社区与接受两年半SVCT的社区相比，近期艾滋病毒感染的流行率将显著降低。此外，我们提出了以下次要目标(目标2)，以检验以下假设：相对于SVCT社区，CBVCT社区将在干预期结束时报告显著的艾滋病毒风险行为；b)更高的艾滋病毒检测率；c)更有利的艾滋病毒检测社会规范；d)更频繁地讨论艾滋病毒；e)更频繁地披露艾滋病毒状况；f)更少与艾滋病毒有关的耻辱；以及g)更少与艾滋病毒有关的社会危害。最后，由于成本效益数据对东道国和捐助国的重要性，我们建议评估(目标3)与潜在潜在风险技术相比，基于成本效益的技术的增量成本效益。 将在基线和干预后从每个社区中随机抽取年龄在18岁至32岁之间的人作为样本，以衡量主要和次要终点。目的1将通过比较研究两个分支中所有艾滋病毒阳性血液样本的敏感/不敏感艾滋病毒检测方法测量的近期感染的干预后流行率来进行评估。目标2将通过比较基线和干预后的各种行为测量来进行评估。目标3将根据避免的艾滋病毒感染和挽救的残疾调整生命年的每项费用进行评估。

DESCRIPTION (provided by applicant): From a public health perspective, there is no more compelling crisis in the world today than the HIV epidemic in the developing world. This is a Phase III community-level randomized controlled study, in which 32 communities in Africa (Tanzania, Zimbabwe, and South Africa) and 14 communities in Thailand will be randomized to either a community-based HIV voluntary counseling and testing (CBVCT) intervention or clinic-based standard VCT (SVCT). The CBVCT intervention has three major strategies: (1) to make VCT more available in community settings; (2) to engage the community through outreach; and (3) to provide post-test support. These three strategies are designed to change community norms and reduce risk for HIV infection among all community members, irrespective of whether they participated directly in the intervention. Thus, a community-level sampling approach as opposed to a cohort design is used to evaluate outcomes. The primary aim (Aim 1) is to test the hypothesis that communities receiving 2-1/2 years of CBVCT, relative to communities receiving 2-1/2 years of SVCT, will have significantly lower prevalence of recent HIV infection. In addition, we propose the following secondary aim (Aim 2) to test the hypotheses that CBVCT communities, relative to SVCT communities, will at the end of the intervention period report significantly: a) less HIV risk behavior; b) higher rates of HIV testing; c) more favorable social norms regarding HIV testing; d) more frequent discussions about HIV; e) more frequent disclosure of HIV status; f) less HIV-related stigma; and g) less HIV-related social harm. Finally, because of the importance of cost-effectiveness data to host and donor countries, we propose to assess (Aim 3) the incremental cost-effectiveness of CBVCT compared to SVCT. A random sample of persons between the ages of 18 and 32 years of age from each community will be selected at baseline and post-intervention for measuring primary and secondary endpoints. Aim 1 will be evaluated by comparing the post-intervention prevalence of recent infection measured by the sensitive/less sensitive HIV assay on all positive HIV blood samples in the two arms of the study. Aim 2 will be evaluated by comparing a variety of behavioral measures at baseline and post-intervention. Aim 3 will be evaluated in terms of cost per HIV infection averted and disability-adjusted life years saved.