When are in-person HIV services worth the risk of COVID-19 and other communicable illnesses? Optimizing choices when virtual services are less effective

什么时候值得冒着感染 COVID-19 和其他传染病的风险去接受面对面的 HIV 服务？

• 批准号: 10481333
• 负责人: Anna Bershteyn
• 金额: $ 80.73万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10481333
• 关键词: 2019-nCoV; AIDS/HIV problem; Adherence; Affect; Africa South of the Sahara; African; Air Movements; Benefits and Risks; COVID-19; COVID-19 mortality; COVID-19 pandemic; COVID-19 risk; Caring; Cause of Death; Clinic; Clinical; Collaborations; Communicable Diseases; Counseling; Country; Crowding; Data; Decision Making; Depression screen; Disease; Effectiveness; Epidemic; Evaluation; Frequencies; Guidelines; HIV; Health; Health Benefit; Home; Hospitalization; Human immunodeficiency virus test; Infection; Influenza; Kenya; Mental Depression; Mental Health; Mental Health Services; Modeling; Outcome; Patients; Performance; Persons; Policies; Population; Prevention; Psychotherapy; Research; Respiratory Disease; Respiratory Tract Infections; Risk; SARS-CoV-2 exposure; SARS-CoV-2 transmission; Services; Social support; Telephone; Teletherapy; Testing; Time; Translating; Tuberculosis; United States National Institutes of Health; Viral Load result; Visit; Work; World Health Organization; Zambia; adherence rate; antiretroviral therapy; base; disability-adjusted life years; disease transmission; experience; improved; infection risk; interest; mHealth; mathematical model; pandemic disease; patient population; patient subsets; peer support; preservation; prevent; priority pathogen; programs; response; retention rate; self testing; telehealth; temporal measurement; therapy adherence; transmission process; virtual

ABSTRACT/SUMMARY Sub-Saharan Africa (SSA) is home to two-thirds of all people living with HIV (PLHIV). During the COVID-19 pandemic, HIV services in sub-Saharan Africa have been adapted to lower-contact alternatives that reduce exposure to SARS-CoV-2, which maintained the effectiveness of some services but reduced the effectiveness of others. For example, multi-month dispensing of antiretroviral therapy (ART) did not reduce retention or viral load suppression, whereas many services involving navigation, social support, and mental health became less effective when delivered in lower-contact manners. Three such services critical to achieving the HIV treatment and prevention targets are HIV testing, treatment of depression, and ART adherence support. In-person HIV counseling and testing was adapted into remote self-testing, with lower rates of linkage to care and commensurate declines in HIV treatment initiation. In-person psychotherapy for depression (a condition affecting 10-15% of PLHIV in SSA) was adapted into teletherapy, with reduced treatment completion and effectiveness. In-person peer support for ART adherence was adapted into telephone and telehealth adherence support, with lower rates of adherence and viral load suppression. As of mid-2021, SSA countries continue to implement these lower-contact alternatives and lack evidence regarding when, and for whom, higher-contact services should resume. We will partner with the Ministries of Health of Zambia and Kenya and local NGOs to identify services that have been adapted into lower-contact alternatives and estimate (Aim 1) incremental effectiveness at treating and preventing HIV, (Aim 2) incremental exposure to COVID-19, tuberculosis, and influenza, and (Aim 3) which patients should use lower-contact services at what times. To estimate incremental effectiveness, we will use program data to compare outcomes in terms of service-specific indicators such as HIV tests performed, changes in depression scores, and changes in ART retention and viral load suppression. Using an HIV transmission and progression model, we will translate these service-specific indicators into comparable estimates of disability-adjusted life-years. To estimate SARS-CoV-2, tuberculosis, and influenza exposure through different service alternatives, we will perform in-field visits to obtain parameters for a Wells-Riley model of respiratory disease transmission. We will combine these estimates with mathematical modeling to the risk of exposure under different pandemic conditions and the resulting risk to health in terms of disability-adjusted life years. Finally, we will compare HIV-related benefits and SARS-CoV-2- related risks for different COVID-19 pandemic conditions and patient sub-populations in order to determine thresholds when higher-contact services should resume. We will furthermore establish targets for how much the effectiveness of lower-contact services would need to improve in order to be widely recommended in the era of COVID-19.

摘要/总结 撒哈拉以南非洲 (SSA) 居住着三分之二的艾滋病毒感染者 (PLHIV)。在新冠肺炎 (COVID-19) 疫情期间 大流行期间，撒哈拉以南非洲地区的艾滋病毒服务已适应低接触替代方案，从而减少 暴露于 SARS-CoV-2，这维持了某些服务的有效性，但降低了有效性 其他人的。例如，几个月的抗逆转录病毒治疗（ART）并没有减少保留或病毒 负荷抑制，而涉及导航、社会支持和心理健康的许多服务变得更少 以低接触方式传递时有效。三项此类服务对于实现艾滋病毒治疗至关重要 预防目标包括 HIV 检测、抑郁症治疗和 ART 依从性支持。面对面的艾滋病毒 咨询和测试改为远程自我测试，与护理和治疗的联系率较低 艾滋病毒治疗开始率相应下降。针对抑郁症（一种病症）的面对面心理治疗 影响 SSA 中 10-15% 的 PLHIV）被改编为远程治疗，治疗完成率减少， 效力。对 ART 依从性的面对面同伴支持已适应电话和远程医疗 依从性支持，具有较低的依从率和病毒载量抑制。截至 2021 年中期，撒哈拉以南非洲国家 继续实施这些接触较少的替代方案，但缺乏关于何时、为谁实施的证据 应恢复更高级别的服务。我们将与赞比亚和肯尼亚卫生部合作 当地非政府组织确定已适应低接触替代方案的服务并进行估算（目标 1） 提高治疗和预防 HIV 的有效性，（目标 2）增加对 COVID-19 的接触， 结核病和流感，以及（目标 3）哪些患者应在什么时间使用低接触服务。到 估计增量有效性，我们将使用计划数据来比较特定服务的结果 指标，例如进行的 HIV 检测、抑郁评分的变化以及 ART 保留和病毒的变化 负载抑制。使用艾滋病毒传播和进展模型，我们将转化这些特定服务 指标纳入残疾调整生命年的可比估计值。估计 SARS-CoV-2、结核病、 以及通过不同的服务选择接触流感的情况，我们将进行实地考察以获取 呼吸道疾病传播 Wells-Riley 模型的参数。我们将把这些估计与 对不同大流行条件下的暴露风险以及由此产生的风险进行数学建模 以残疾调整生命年来衡量的健康状况。最后，我们将比较 HIV 相关益处和 SARS-CoV-2- 不同的 COVID-19 大流行病和患者亚群的相关风险，以便确定 何时应恢复更高级别的服务的阈值。我们还将进一步制定目标 需要提高低接触服务的有效性，以便在 COVID-19 时代。