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/摘要 撒哈拉以南非洲（SSA）是所有患有艾滋病毒（PLHIV）的人中三分之二的家。在19日期间 大流行，撒哈拉以南非洲的艾滋病毒服务已适应降低的较低接触替代品 暴露于SARS-COV-2，它保持了某些服务的有效性，但降低了有效性 别人。例如，抗逆转录病毒疗法（ART）的多个月分配不会减少保留率或病毒 负载抑制，而许多涉及导航，社会支持和心理健康的服务变得更少 以较低接触的方式提供有效。三个这样的服务对于实现艾滋病毒治疗至关重要 预防目标是艾滋病毒测试，抑郁症治疗和艺术依从性支持。面对面的艾滋病毒 咨询和测试适应了远程自我测试，与护理的联系率较低 艾滋病毒治疗开始时相称的下降。抑郁症的面对面心理治疗（疾病 影响SSA中10-15％的PLHIV）适应远程疗法，治疗完成和 效力。面对面的同伴支持艺术依从性被改编为电话和远程医疗 依从性支持，依从性和抑制病毒载荷率较低。截至2021年中，SSA国家 继续实施这些较低接触的替代方案，缺乏证据表明何时，何时和谁 更高接触服务应恢复。我们将与赞比亚和肯尼亚健康部以及 当地非政府组织以识别已适应低接触替代方案的服务并估算（AIM 1） 在治疗和预防艾滋病毒方面的增量有效性，（AIM 2）增量暴露于COVID-19， 结核病和流感，以及（AIM 3）患者应在什么时候使用低接触服务。到 估计有效性，我们将使用程序数据来比较特定于服务的结果 诸如进行HIV测试的指标，抑郁得分的变化以及ART保留和病毒的变化 负载抑制。使用艾滋病毒传播和进步模型，我们将翻译这些特定服务 指标是对残疾调整的生命年份的可比估计。估计SARS-COV-2，结核病， 以及通过不同的服务替代方案的流感暴露，我们将进行现场访问以获得 Wells-Riley呼吸道疾病传播模型的参数。我们将将这些估计与 数学建模，以在不同的大流行条件下暴露的风险以及导致的风险 在残疾调整的生活年份中的健康。最后，我们将比较与HIV相关的好处和SARS-COV-2- 不同的COVID-19-19大流行状况和患者子人群的相关风险，以确定 何时应恢复较高接触服务时的阈值。我们将建立目标的目标 低接触服务的有效性将需要改进，以便在 Covid-19时代。