HIV VCT and Linkage to Care in Uganda

描述（由申请人提供）：我们建议在一项随机对照试验中研究在常规HIV VCT（rVCT）的背景下优化风险降低的策略，并将住院咨询和检测与出院后的HIV医疗护理完全整合，以确保确诊患者获得护理（包括抗逆转录病毒治疗，如有指征）。我们将使用2 × 2析因设计来评估（a）两种HIV VCT模式和（B）两种与护理联系的策略的效果。这种高效的设计是在一项研究中测试多种干预措施的经济策略，我们的试点研究表明，我们可以在分配的时间段内满足该设计所需的入组目标。第一项干预措施将采用非劣效性研究设计，将住院患者常规咨询和检测（rVCT）与传统的HIV检测前和检测后咨询和检测（tVCT）进行比较。第二项干预措施将采用一种优越性设计，与通常的转诊相比，对血清反应阳性者采用“加强与护理的联系”模式，以增加对艾滋病毒专门医疗护理的接受和长期利用。本研究的主要具体目的是：具体目标1（rVCT与tVCT）：检验假设（非劣效性假设），即住院成人中常规的HIV咨询和检测在降低出院后住院患者的HIV风险行为方面与传统的咨询和检测一样有效。具体目标2（加强联系与家庭转诊）：检验假设（优越性假设），即在接受OI预防、ART和降低死亡率方面，披露后转诊到HIV特异性医疗护理的“加强护理联系”模式比常规转诊更有效。

DESCRIPTION (provided by applicant): We propose to examine in a randomized controlled trial strategies for optimizing risk reduction within the context of routine HIV VCT (rVCT) and fully integrating inpatient counseling and testing with post-discharge HIV medical care to ensure that diagnosed individuals receive access to care (including antiretroviral therapy if indicated). We will use a 2 x 2 factorial design to assess the effects of (a) two modes of HIV VCT and (b) two strategies for linkage to care. This highly efficient design is an economical strategy of testing multiple interventions in a single study, and our pilot studies demonstrate that we can meet enrollment targets required by this design within the allocated time period. The first intervention will compare, in a non-inferiority study design, in-patient routine counseling and testing (rVCT) with traditional HIV pre- and post-test counseling and testing (tVCT). The second intervention will compare, in a superiority design, an "enhanced linkage to care" model for seropositive persons to increase uptake and long-term utilization of HIV-specific medical care, compared to usual referral. The primary specific aims of the study are to: Specific Aim 1 (rVCT vs tVCT): Test the hypothesis (non-inferiority hypothesis) that routine counseling and testing for HIV among hospitalized adults is as efficacious as traditional counseling and testing in reducing HIV risk behavior among inpatients after discharge. Specific Aim 2 (Enhanced Linkage vs. Usual Referral): Test the hypothesis (superiority hypothesis) that an "enhanced linkage to care" model of post-disclosure referral to HIV-specific medical care is more effective than usual referral in receipt of Ol prophylaxis, ART, and reducing mortality.