ITEST: Innovative Tools to Expand Youth-Friendly HIV Self-Testing

ITEST：扩大青少年友好的艾滋病毒自我检测的创新工具

• 批准号: 10470245
• 负责人: Juliet Iwelunmor
• 金额: $ 128.52万
• 依托单位: SAINT LOUIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2023-09-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10470245
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Africa; Africa South of the Sahara; African; American; Anal Sex; Area; Behavioral; Benchmarking; Chlamydia; Clinical Trials Data Monitoring Committees; Communities; Country; Creativeness; Data; Decentralization; Development; Effectiveness; Ensure; Epidemic; Evaluation; Fright; Goals; Gonorrhea; Government; Guidelines; HIV; HIV Infections; HIV Seronegativity; Human immunodeficiency virus test; Incidence; Individual; Infection; Institutional Review Boards; Intervention; Learning; Link; Local Government; Mentorship; Modality; National Institute of Child Health and Human Development; Newly Diagnosed; Nigeria; Nigerian; Outcome; Patient Self-Report; Persons; Phase; Policies; Prevention strategy; Preventive; Preventive service; Privacy; Procedures; Process; Public Health; Randomized; Randomized Controlled Trials; Request for Applications; Research; Research Priority; Risk; Sampling; Services; Sexually Transmitted Diseases; Social Problems; Social support; Specimen; Syphilis Serodiagnosis; Testing; United States National Institutes of Health; Vagina; World Health Organization; Youth; age group; aged; apprenticeship; authority; base; community based participatory research; condoms; design; disparity reduction; effectiveness evaluation; experience; experimental study; high risk; implementation intervention; implementation strategy; improved; innovation; low and middle-income countries; multidisciplinary; pre-exposure prophylaxis; preference; prevent; prevention service; primary outcome; recruit; resilience; response; secondary outcome; self testing; service uptake; skills; social; social stigma; success; supportive environment; testing services; therapy development; tool; transmission process; trial readiness; uptake; willingness

ABSTRACT HIV incidence remains high among youth aged 14-24 in Sub-Saharan Africa, thus underscoring the importance of interventions to prevent HIV in this age group. Nigerian youth are at the epicenter of an expanding HIV crisis, with the second largest number of new youth HIV infections of any country. Yet fewer than one in five Nigerian youth have ever been HIV tested. Young people are often framed as the fraught victims of new HIV infections, instead of recognizing their resilience and power in advancing effective response to the epidemic. Conventional expert-driven, top-down interventions have largely failed. Innovative solutions that leverage the resourcefulness and resilience of youth are sorely needed. In this proposal, we will develop innovative youth-friendly HIV self-testing services based on open challenges and apprenticeships that are informed by a youth participatory action research framework. Open challenges solicit solutions from the community and then implement the best solutions, while apprenticeship builds local capacity for youth-led projects to increase the likelihood of success and ensure comprehensive evaluation. Three randomized controlled trials based on open challenges have led to improved rates of HIV testing and condom use among at-risk youth, but none of these approaches have been in Africa. These participatory approaches will be used to identify innovative HIV self-testing strategies that meet the specific needs of Nigerian youth. Each strategy will have a comprehensive plan for enhancing HIV prevention (including HIV pre- exposure prophylaxis and behavioral approaches) among at-risk youth. Two HIV self-testing strategies will be selected by judges as semi-finalists and evaluated in separate local government area pilots (UG3 phase). Once the project meets stringent requirements demonstrating trial readiness and pilot effectiveness, a single strategy will be evaluated in a pragmatic, cluster randomized controlled trial in 24 local government areas of Nigeria (UH3 phase). The intervention development process will build capacity for decentralized HIV self- testing, drawing on the strengths, creativity, and engagement of Nigerian youth. Leveraging our extensive experience organizing HIV research in Nigeria, we propose the following specific aims: (1) To use open challenges and apprenticeship to develop new HIV self-testing services; (2) To evaluate the effectiveness of two semi-finalist participatory interventions on HIV testing and other key prevention services among at-risk, HIV-negative youth (14-24years old); (3) To determine the effectiveness of a finalist participatory intervention on HIV testing and other key HIV prevention outcomes in 24 areas using a stepped wedge, pragmatic randomized controlled trial. The overarching goal is not to create a monolithic “one-size fits all” HIV self-testing strategy, but rather to demonstrate that open challenges can engage and inspire youth to develop innovative and effective HIV services. Our focus on open challenges and tailoring services to youth resonates with NICHD, NIH, and US government strategic priorities.

抽象的 在撒哈拉以南非洲14-24岁的青年中，艾滋病毒事件仍然很高，因此强调了 干预措施以防止该年龄段的艾滋病毒的重要性。尼日利亚青年是 扩大艾滋病毒危机，任何国家的新青年艾滋病毒感染中第二大。较少 比尼日利亚青年中有五分之一接受过艾滋病毒的测试。年轻人通常被构成弗劳德 新的艾滋病毒感染的痛苦，而不是认识到其韧性和提高有效的能力 对流行病的反应。传统的专家驱动的自上而下的干预措施在很大程度上失败了。创新的 迫切需要利用青年的机智和韧性的解决方案。在此提案中，我们将 基于公开挑战和学徒制，开发创新的青年友好的艾滋病毒自我测试服务 青年参与行动研究框架所告知的。开放挑战来自 社区，然后实施最佳解决方案，而学徒制则建立了以青年为主导的当地能力 提高成功可能性并确保全面评估的项目。三个随机分组 基于公开挑战的对照试验导致艾滋病毒测试和避孕套使用率提高 处于危险中的青年，但这些方法都没有在非洲。这些参与方法将被使用 确定满足尼日利亚青年特定需求的创新艾滋病毒自我测试策略。每个策略 将制定一项全面的计划，以增强艾滋病毒预防（包括预防艾滋病毒， 行为方法）在高危青年中。法官将选择两种艾滋病毒自我测试策略 半决赛选手并在不同的地方政府地区飞行员（UG3阶段）进行了评估。一旦项目见面 严格的要求证明了试验阅读和飞行员有效性，将是一个策略 在尼日利亚24个地方政府地区的一项务实的，群集随机对照试验中进行评估（UH3） 阶段）。干预开发过程将为分散的艾滋病毒自我测试，绘画增强能力 关于尼日利亚青年的优势，创造力和参与。利用我们的丰富经验 在尼日利亚组织艾滋病毒研究，我们提出以下具体目的：（1）使用公开挑战和 为开发新的艾滋病毒自我测试服务的学徒制； （2）评估两个半决赛的有效性 艾滋病毒测试和其他关键预防服务的参与干预措施 青年（14-24岁）； （3）确定决赛选手参与艾滋病毒的有效性 使用阶梯楔形，务实的随机进行测试和其他关键的HIV预防结果 对照试验。总体目标不是创建一个单片的“一件尺寸适合所有人”的艾滋病毒自我测试策略，而是 而是要证明，公开挑战可以参与并激发青年发展创新的挑战，并且 有效的艾滋病毒服务。我们关注的是开放挑战和为青年人量身定制服务与NICHD共鸣， NIH和美国政府的战略重点。

项目成果

Sustaining HIV Research in Resource-Limited Settings Using PLAN (People, Learning, Adapting, Nurturing): Evidence from the 4 Youth by Youth Project in Nigeria.

• DOI: 10.1007/s11904-023-00652-2
• 发表时间: 2023-04
• 期刊: Current HIV/AIDS reports
• 影响因子: 4.6

Understanding factors that promote uptake of HIV self-testing among young people in Nigeria: Framing youth narratives using the PEN-3 cultural model.

• DOI: 10.1371/journal.pone.0268945
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7

Costs of implementing community-based intervention for HIV testing in sub-Saharan Africa: a systematic review.

在撒哈拉以南非洲实施基于社区的艾滋病毒检测干预措施的成本：系统评价。

• DOI: 10.1186/s43058-021-00177-y
• 发表时间: 2021-07-05
• 期刊: Implementation science communications
• 作者: Uzoaru F;Nwaozuru U;Ong JJ;Obi F;Obiezu-Umeh C;Tucker JD;Shato T;Mason SL;Carter V;Manu S;BeLue R;Ezechi O;Iwelunmor J
• 通讯作者: Iwelunmor J

Designing HIV Testing and Self-Testing Services for Young People in Nigeria: A Discrete Choice Experiment.

• DOI: 10.1007/s40271-021-00522-2
• 发表时间: 2021-11
• 期刊: The patient
• 作者: Ong JJ;Nwaozuru U;Obiezu-Umeh C;Airhihenbuwa C;Xian H;Terris-Prestholt F;Gbajabiamila T;Musa AZ;Oladele D;Idigbe I;David A;Okwuzu J;Bamidele T;Iwelunmor J;Tucker JD;Ezechi O
• 通讯作者: Ezechi O