Enhancing communication on relationship preservation, safer conception and PrEP to promote HIV testing

项目总结 要在撒哈拉以南非洲实现95-95-95目标，优化艾滋病毒检测是至关重要的。30%的新客户 感染发生在已婚或同居的夫妇中，最大限度地在符合或 可能有一天，认真的异性恋关系已经被确定为最划算的 遏制疫情的战略。在整个撒哈拉以南非洲地区，生育受到高度重视，人们担心 关系的破裂和生育能力的丧失仍然是艾滋病毒检测的重大障碍。这个 扩大暴露前预防(PrEP)的可获得性提供了一个机会，通过 战略沟通(非MH-21-105)，让夫妻相信他们有能力拥有一个健康的家庭 如果其中一个或两个成员都是艾滋病毒阳性者。我们的长期目标是利用PrEP日益增长的可用性 确定沟通策略是否以及如何侧重于关系维护和更安全的概念 可以增加合作伙伴之间的检测和进入治疗(抗逆转录病毒疗法)或预防(PrEP) 乌干达的个人。我们最近在乌干达的援助下成功地试行了这一沟通策略 合作伙伴通知计划(APN)。在本R34中，我们将：(1)进行形成性研究，以扩展 将传播战略转变为覆盖范围更广的多组件干预；以及(2)进行 干预，让健康的家庭受益。为了达到目标1，我们将与社区咨询委员会合作。 (CAB)为a)创建沟通材料(手册、脚本)和定制咨询方案 在APN和产前护理(ANC)中为客户和合作伙伴提供一系列夫妇测试路径。AS 在此开发阶段，CAB提供商与客户和合作伙伴一起试行材料和跟踪系统， 研究人员将进行实地观察和定性访谈，重点是可行性和可接受性， 通知修订后的干预材料。为了实现目标2，我们将收集APN和ANC的基线数据 在九个月的时间里，两个大型公共医疗机构内的诊所。然后将对站点进行随机化，以实施 在接下来的九个月里为健康的家庭或他们现有的沟通方式(通常的护理)做准备。 我们将通过APN/ANC的干预跟踪收集关于可行性和可接受性的混合方法数据 登记、客户退出调查，以及对客户、合作伙伴和供应商的定性访谈。直通寄存器 提取，我们将检查与更大规模试验(伙伴艾滋病毒)相关的结果的有限疗效 测试、启动PrEP/ART的客户服务吸收)，并探索潜在的主持人。总体而言，结果将 在前景看好的新通信战略(非MH-21-105)中获得重要见解，该战略可能会连接更多 个人对艾滋病毒的治疗或预防的护理级联，并使我们为大规模的集群做好准备 确定对PrEP/ART检测和启动的影响的随机对照试验。

PROJECT SUMMARY Optimizing uptake of HIV testing is critical to meeting 95-95-95 goals in sub-Saharan Africa. As 30% of new infections in occur within married or cohabitating couples, maximizing testing among individuals who are or may someday be in serious heterosexual relationships has been identified as one of the most cost-effective strategies to curb the epidemic. Childbearing is highly valued throughout Sub-Saharan Africa, and fears of relationship dissolution and loss of the ability to have children remain significant barriers to HIV testing. The expanding availability of pre-exposure prophylaxis (PrEP) presents an opportunity to counter these fears with strategic communication (NOT-MH-21-105) that reassure couples of their ability to have a healthy family even if one or both members are HIV positive. Our long-term objective is to leverage the growing availability of PrEP to determine if and how a communication strategy focused on relationship preservation and safer conception can increase testing and entry into treatment (antiretroviral therapy) or prevention (PrEP) among partnered individuals in Uganda. We recently successfully piloted this communication strategy within Uganda’s assisted partner notification program (APN). In this R34, we will: (1) conduct formative research to expand the communication strategy into a multi-component intervention with broader reach; and (2) conduct a pilot trial of the intervention, PrEPing Healthy Families. To achieve Aim 1, we will work with a community advisory board (CAB) of providers to a) create communication materials (brochures, scripts) and counseling protocols tailored to clients and partners across the array of couples’ testing pathways in APN and antenatal care (ANC). As CAB providers pilot materials and tracking systems with clients and partners during this development phase, study staff will conduct field observations and qualitative interviews focused on feasibility and acceptability, informing revised intervention materials. To achieve Aim 2, we will collect baseline data at APN and ANC clinics within two large public healthcare facilities over nine months. Sites will then be randomized to implement PrEPing Healthy Families or their existing communication approach (usual care) over the next nine months. We will collect mixed-methods data on feasibility and acceptability through intervention tracking in APN/ANC registers, client exit surveys, and qualitative interviews with clients, partners and providers. Through register extraction, we will examine limited efficacy on outcomes that would be relevant to a larger trial (partner HIV testing, client service uptake initiation of PrEP/ART), and explore potential moderators. Overall, results will yield important insights in a promising new communication strategy (NOT-MH-21-105) that may connect more individuals to the HIV cascades of care for treatment or prevention and prepare us for a large-scale, cluster randomized controlled trial to determine impact on testing and initiation of PrEP/ART.