Innovations in HIV testing to enhance care for young women and their partners

 描述(由申请人提供)：艾滋病毒咨询和检测(HCT)、联系和护理的显著改进对于扭转艾滋病毒流行的趋势至关重要。实现普遍获得艾滋病毒预防和治疗的第一步是大幅增加所有南非成年人接受年度艾滋病毒检测。扩大艾滋病毒检测和转诊战略，包括通过社会/性网络进行自我检测，可能会改善早期发现，特别是在难以接触到、有未诊断艾滋病毒感染病例的人群中。在这项研究中，我们建议解决RFA-AI-14-009中确定的三个关键领域：年轻女性的艾滋病毒预防，组合预防战略，以及识别感染者和与护理的联系，探索艾滋病毒自我检测如何提高年轻女性及其同龄人和伴侣的检测覆盖率和频率，从而减少未诊断感染的负担，改善护理进入。我们建议在姆普马兰加省农村的阿金库尔健康和社会人口监测点随机选择400名年轻妇女接受基于诊所的HCT或选择HCT或HIV自我检测。将鼓励年轻女性邀请2个朋友和最多2个伴侣使用这一策略进行艾滋病毒检测 他们被分配或已经选择，导致多达1600个朋友/合作伙伴被转介进行测试。将跟踪年轻女性和同意的同龄人/伴侣，从数量和质量两方面评估研究结果。有待探索的结果包括测试吸收、测试转诊、 检测的频率、新阳性的诊断以及与护理的联系。阿金库尔研究平台旨在实现高度的后续行动和队列完整性。结果将通过研究ARM进行比较。那些检测呈阳性的人将被建议并鼓励链接到关怀，包括收到促进链接的短信，并积极链接那些在3个月内未能提交CD4检测结果的人。这将是衡量撒哈拉以南非洲这一极高风险群体年轻女性接受自我测试的首批研究之一，并将阐明扩大测试选择如何影响年轻女性、她们的同龄人和伴侣对测试的接受。到目前为止，尚不清楚年轻人是否会进行自我检测，自我检测是否可以提高检测频率，朋友和伴侣的推荐是否会导致更多的检测吸收和识别未诊断的感染，以及那些自我检测是否会与护理联系起来。我们的工作将使扩大艾滋病毒检测和与南非护理的联系的规模扩大。如果发现有效，拟议的干预措施将提供公共卫生工具，加强艾滋病毒检测，并与受艾滋病毒影响不成比例的人群的护理联系起来--这是政府2012-16年国家战略计划的关键目标。

 DESCRIPTION (provided by applicant): Significant improvement to HIV counseling and testing (HCT), linkage and care are critical to turn the tide of the HIV epidemic. The first step i reaching universal access to HIV prevention and treatment is to significantly increase uptake of annual HIV testing among all South African adults. Expanding HIV testing and referral strategies to include self-testing through social/sexual networks may improve early detection, particularly among hard-to-reach populations with undiagnosed cases of HIV infection. In this study, we propose to address three key areas identified in RFA-AI-14-009: HIV prevention in young women, combination prevention strategies, and identification of infected individuals and linkage to care by exploring how self-testing for HIV may improve testing coverage and frequency among young women and their peers and partners, thus decreasing the burden of undiagnosed infections and improving entry into care. We propose randomizing 400 young women in the Agincourt Health and Socio-demographic Surveillance Site in rural Mpumalanga Province, to receipt of clinic-based HCT or to choice of either HCT or HIV self-testing. Young women in both arms will be encouraged to invite 2 friends and up to 2 partners to test for HIV using the strategy they are assigned or have chosen, leading to referral of up to 1600 friends/partners for testing. Young women and consenting peers/partners will be followed to assess study outcomes both quantitatively and qualitatively. Outcomes to be explored include testing uptake, testing referral, frequency of testing, diagnosis of new positives, and linkage to care. The Agincourt research platform is purpose-designed to achieve high follow-up and cohort integrity. Outcomes will be compared by study arm. Those who test positive will be counseled and encouraged to link to care, including receipt of text messages to promote linkage and actively linking those who fail to present for CD4 test results within 3 months. This will be among the first studies to measure the uptake of self-testing among young women in sub-Saharan Africa, a group at extremely high risk, and will elucidate how expanded testing choices can impact testing uptake for young women, their peers and partners. To date it is unknown whether young people will take up self-testing, whether self-testing can improve testing frequency, whether referral of friends and partners will result in greater testing uptake and identification of undiagnosed infections, and whether those that self-test will link to care. Our work will inform scale up of expanded HIV testing and linkage to care in South Africa. The proposed intervention, if found efficacious, will provide public health tools that increase HIV testing and linkage to care among a population disproportionately affected by HIV - a key objective in Government's 2012-16 National Strategic Plan.