Family-Based HIV VCT in Patients at Risk for TB

说明(申请人提供)：全球呼吁在撒哈拉以南非洲迅速采用艾滋病毒抗逆转录病毒疗法，迫切需要改进艾滋病毒感染者的识别，并与艾滋病毒医疗和社会支持成功挂钩。艾滋病毒自愿咨询和检测(VCT)已被证明在帮助个人了解他们的艾滋病毒状况和进入护理方面有效。结核病(TB)患者是VCT识别艾滋病毒感染和将个人联系到艾滋病毒特定护理中的最大机会之一。在发展中国家，艾滋病毒流行与先前存在的结核病流行有很大重叠，新诊断的结核病患者中艾滋病毒流行率超过50%。与普通人群相比，结核病患者的家庭和家庭成员，特别是配偶和年幼子女的艾滋病毒感染率也大大增加。然而，在所有这些人群中，VCT的使用率很低(&lt；10%)。我们建议测试利用HIV快速检测和将HIV VCT整合到结核病评估和家庭成员家庭VCT中的干预措施的有效性，以克服新结核病患者HIV及其家庭成员对HIV VCT的已确定的后勤和心理障碍。这项研究的具体目的是：1)确定2,000名结核病评估患者的横断面样本中接受VCT的情况和阻碍VCT的障碍。2)在600户家庭中进行HIV VCT的随机试验，比较家庭VCT和结核病诊所VCT对结核病评估患者家属和家庭成员的VCT摄取率。3)研究以家庭和结核病诊所为基础的VCT在将600个随机家庭中的HIV感染者联系到HIV医疗和社会支持方面的有效性。

DESCRIPTION (provided by applicant): The global call for the rapid introduction of HIV antiretroviral therapy to sub-Saharan Africa urgently requires improved identification of HIV infected persons and successful linkage to HIV medical care and social support. Voluntary Counseling and Testing (VCT) for HIV has been shown to be effective in helping individuals learn their HIV status and get into care. Tuberculosis (TB) patients present one of the greatest opportunities for VCT to identify HIV infections and link individuals into HIV specific care. In the developing world, the HIV epidemic overlaps significantly with pre-existing epidemics of TB and the HIV prevalence among individuals newly diagnosed with TB is greater than 50%. Family and household members of TB patients, especially spouses and young children, also have a greatly elevated prevalence of HIV infection compared to that of the general population. However, VCT use among all these groups is low (<10%). We propose to test the efficacy of an intervention utilizing HIV rapid testing and integration of HIV VCT into TB evaluation and home-based VCT for family members, to overcome identified logistical and psychological barriers to HIV VCT among new TB patients HIV and their family members. The specific aims of the study are: 1) To determine the uptake of and barriers to VCT among a cross-sectional sample of 2,000 TB evaluation patients offered same-day results HIV counseling and testing at the Uganda National TB and , Leprosy Programme outpatient TB clinic at Old Mulago Hospital in Kampala, Uganda. 2) To conduct a randomized trial of HIV VCT among 600 households comparing VCT uptake between Home-based VCT and TB Clinic-based VCT for family and household members of TB evaluation patients. 3) To investigate the effectiveness of Home-based and TB Clinic-based VCT in linking HIV infected persons among the 600 randomized households to HIV medical care and social support.