Know Your Network: A concurrency reduction intervention

描述（由申请人提供）：本提案寻求对形成性研究的支持，以改进侧重于并发伙伴关系的艾滋病毒预防干预。当一个人在结束与前任伴侣的关系之前开始与新伴侣发生性关系时，就会发生并发性行为。十多年的研究表明，这种行为增加了人群中流行的可能性。越来越多的证据表明，在解释撒哈拉以南非洲地区艾滋病毒的普遍流行方面，同时发病是一个关键因素，越来越多的人一致认为，有必要试验一项减少同时发病的干预措施。我们有一个基于“了解你的网络”（KYN）概念的社区水平并发干预的随机试验的初步设计。它是从肯尼亚西部的研究传播活动演变而来的，旨在将其整合到撒哈拉以南非洲开始的家庭咨询和检测（HCT）的推广中。干预有两个组成部分，我们在这里试图评估村一级的活动：(1)一套互动练习，旨在提高对并发性的认识，并培养对并发性如何增加社区一级艾滋病毒传播风险的直观理解；(2)一个简短的9个问题的调查，要求参与者提供关于性伙伴关系时间和顺序的匿名行为数据，这些数据通过手持设备收集，集中下载并在现场转换为模拟他们的性伙伴关系网络，并进行集体讨论。如果这种干预能够被证明是可行的、可接受的和质量上有效的，我们已经确定了一个地点，可以将其整合到三个连续的HCT浪潮中，从而有可能确定与联合干预相关的艾滋病毒发病率的变化。目前的提案寻求对这一阶段所需的形成性研究的支持。具体目标是：(1)利用与村长和长老、社区代表和保健工作者举行的传统东非参与式会议（mabaraza），以及与社区成员进行焦点小组讨论，改进村一级活动的设计，这些活动将作为KYN干预措施的一部分；(2)在预定的一轮HCT之后立即在一个村庄进行一次全面的试验，对KYN干预措施进行预测试；(3)使用mabaraza方法评估干预措施，并根据需要进行修改。如果成功，这一干预措施大有希望，因为它利用了“群体免疫”原则，以最小的行为减少来最大限度地减少传播。

DESCRIPTION (provided by applicant): This proposal seeks support for formative research to refine an HIV prevention intervention that focuses on concurrent partnerships. Concurrency happens when a person begins a sexual relationship with a new partner before ending a relationship with a previous partner. Over a decade of research has shown that this behavior increases the epidemic potential in a population. Evidence also increasingly suggests that concurrency plays a key role in explaining the generalized epidemics of HIV in the sub-Saharan African region, and there is growing consensus that a trial of a concurrency reduction intervention is needed. We have a preliminary design for a randomized trial of a community-level concurrency intervention based on the concept of "Know Your Network" (KYN). It evolved from study dissemination activities in Western Kenya and is designed to be integrated into the rollout of home based counseling and testing (HCT) that is beginning throughout sub-Saharan Africa. The intervention has a two component, village-level activity that we seek to evaluate here: (1) a set of interactive exercises aimed at increasing awareness of concurrency and fostering an intuitive understanding of how concurrency increases the community level risk of HIV spread; (2) a brief 9 question survey that engages the participants in providing anonymous behavioral data on the timing and sequence of sexual partnerships, which is collected using handheld devices, centrally downloaded and transformed on site into simulations of their sexual partnership network, and discussed collectively. If this intervention can be shown to be feasible, acceptable and qualitatively effective, we have identified a site where it can be integrated into three successive waves of HCT, making it possible to identify changes in HIV incidence associated with the combined interventions. The current proposal seeks support for the formative research needed at this stage. The specific aims are to: (1) Refine the design of the village-level activities that will be used as part of the KYN intervention, using traditional East African participatory meetings (mabaraza) with village chiefs and elders, community representatives and health care workers, and focus group discussions with community members; (2) Pretest the KYN intervention with one full trial run in a single village immediately following a scheduled round of HCT; and (3) Evaluate the intervention using the mabaraza method and modify as needed. If successful, this intervention has great promise because it leverages the principle of "herd immunity" to obtain maximal reductions in transmission with minimal reductions in behavior. PUBLIC HEALTH RELEVANCE: Concurrent sexual partnerships appear to play an important role in explaining the severe generalized epidemics in the sub-Saharan African region. This project develops a concurrency reduction intervention designed to be integrated into the new community oriented programs of home-based counseling and testing. This combination of behavioral and biomedical interventions offers a natural integration of testing, treatment and prevention, and a unique opportunity to conduct a rapid, economical randomized trial of the effectiveness of this approach.