Transformative approaches to rapidly and efficiently test demand creation interventions to promote HIV retesting in adults at increased risk of HIV

项目摘要 在艾滋病毒高危人群中进行频繁的艾滋病毒检测对于实现早期诊断和迅速 启动抗逆转录病毒治疗--减少发病率和消除传播的关键步骤。艾滋病毒重新检测可以 还支持正在进行的扩大暴露前预防措施的努力。尽管指导方针建议经常 来自撒哈拉以南非洲的研究表明，在风险较高的成年人中进行重新检测 很少见。 行为经济学提供了关于为什么人们可能不会从事艾滋病毒重新检测等行为的见解。低 艾滋病毒重新检测源于结构性因素(例如耻辱和机会成本)，以及各种偏见和 人们的信念和行为中的启发式，注意力的限制，以及对不正确心理模型的依赖。 行为经济学也发现了能有效解释这些问题的低成本干预措施(“轻推”)。 行为特征。在我们先前工作的基础上，我们已经确定了艾滋病毒重新检测的障碍，我们已经应用了 选择在解决心理基础方面有效的轻推的行为设计框架 重新测试的每一道障碍。我们将通过参与性的方式使微调适应艾滋病毒重新检测和当地情况 将科学家和最终用户聚集在一起的原型方法。然后我们将进行大规模的，多方面的 ARM现场实验，以个体随机化为特色，测试许多不同的轻推。这场“巨型审判” 最近，一种方法被用于测试行为干预措施，以促进美国的其他健康行为 与仅测试1到2个干预措施的标准实验相比，该方法具有许多优势。带着相同的 所有研究机构都在检查结果，大型试验允许对不同干预措施进行直接比较。 与双臂实验不同的是，它们还使确定哪些干预措施对谁最有效成为可能。 利用蓝宝石试验的基础设施进行新型艾滋病毒生物医学预防和治疗 在肯尼亚和乌干达，我们将招募一大批艾滋病毒高危人群进行研究 进行一项低成本行为干预的大型试验，以促进艾滋病毒重新检测。该项目将拥有 以下目标： 目标1.调整行为经济学干预措施，以促进使用参与式原型进行艾滋病毒重新检测 在肯尼亚和乌干达的农村地区采用这种方法。目标2.确定许多行为经济学的有效性 在一项多臂随机试验中促进高危成人艾滋病毒重新检测的干预措施。目标3.估算 不同的治疗效果和确定最佳的需求创造干预措施。 我们建议的研究可以加快发现干预措施的步伐，以增加艾滋病毒重新检测和 改变未来设计、测试和比较健康行为干预措施的方法。

Project Summary Frequent HIV testing among persons at increased HIV risk is crucial for achieving early diagnosis and prompt antiretroviral therapy initiation – key steps to reducing morbidity and eliminating transmission. HIV retesting can also support ongoing efforts to scale-up pre-exposure prophylaxis. Despite guidelines recommending frequent retesting among adults at higher risk, studies from sub-Saharan Africa suggest that retesting occurs infrequently. Behavioral economics provides insights into why people may not engage in behaviors like HIV retesting. Low HIV retesting stems from structural factors (e.g. stigma and opportunity costs), as well as various biases and heuristics in people’s beliefs and behavior, constraints in attention, and reliance on incorrect mental models. Behavioral economics has also identified low-cost interventions (“nudges”) that effectively account for these features of behavior. Building on our prior work that has identified barriers to HIV retesting, we have applied a Behavioral Design framework to select nudges that are effective in addressing the psychological underpinnings of each barrier to retesting. We will adapt the nudges to HIV retesting and local contexts through a participatory prototyping approach that brings together scientists and end users. We will then conduct a large-scale, multi- arm field experiment that features individual randomization and tests many different nudges. This “mega-trial” approach has recently been used to test behavioral interventions to promote other health behaviors in the US and offers many advantages over standard experiments that only test 1 or 2 interventions. With the same outcome being examined in all study arms, mega-trials allow for direct comparison of different interventions. Unlike 2-arm experiments, they also make it possible to identify which interventions work best for whom. Leveraging the infrastructure of the SAPPHIRE trial of novel HIV biomedical prevention and treatment approaches in Kenya and Uganda, we will enroll a large study population of persons at high risk of HIV to conduct a mega-trial of low-cost behavioral interventions to promote HIV retesting. The project will have the following aims: AIM 1. Adapt behavioral economics interventions to promote HIV retesting using a participatory prototyping approach in rural Kenya and Uganda. AIM 2. Determine the effectiveness of many behavioral economics interventions to promote HIV retesting among high-risk adults in a multi-arm randomized trial. AIM 3. Estimate heterogeneous treatment effects and identify optimal demand creation interventions. The research we propose can accelerate the pace of discovery of interventions to increase HIV retesting and transform future approaches to designing, testing and comparing interventions for health behaviors.