Improving HIV testing, linkage, and retention in care for men through U=U messaging

通过 U=U 信息传递改善男性的 HIV 检测、联系和护理保留

• 批准号: 10483486
• 负责人: Alison Meredith Buttenheim
• 金额: $ 59.2万
• 依托单位: DESMOND TUTU HIV FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10483486
• 关键词: AIDS prevention; Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Africa South of the Sahara; Anxiety; Area; Behavioral Sciences; Caring; Clinic; Collaborations; Communicable Diseases; Communities; Continuity of Patient Care; Counseling; Country; Coupled; Data; Effectiveness; Effectiveness of Interventions; Epidemic; Epidemiology; Evaluation; Fright; Gender; Goals; Government; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Benefit; High Prevalence; Human immunodeficiency virus test; Incidence; Income; Intervention; Knowledge; Learning; Methods; Outcome; Participant; Penetration; Persons; Prevalence; Process; Province; Randomized; Research; Resources; Safe Sex; Sexual Partners; Shapes; Site; South Africa; Testing; Unsafe Sex; Viral; Viral Load result; Woman; Work; antiretroviral therapy; base; behavioral economics; cis-male; clinical practice; contextual factors; effectiveness evaluation; effectiveness-implementation RCT; experience; future implementation; human centered design; implementation barriers; implementation efforts; implementation facilitation; improved; innovation; insight; male health; men; mortality risk; peer; primary outcome; prototype; randomized trial; secondary outcome; service delivery; service uptake; sexual HIV transmission; standard of care; successful intervention; testing services; testing uptake; theories; therapy adherence; tool; treatment adherence; treatment as prevention; uptake; yeast two hybrid system

PROJECT ABSTRACT Increasing the coverage of HIV testing and treatment among people living with HIV (PLHIV) is essential for ending the global AIDS epidemic. Unfortunately, compared to women, men living with HIV (MLHIV) are less likely to know their HIV status, start anti-retroviral treatment, or achieve viral suppression. Given that new HIV infections among women are driven, in part, by men’s testing and treatment gaps, reducing the gender gap in testing uptake, treatment initiation and achievement of viral suppression by men must be prioritized in order to accelerate the decline in HIV incidence among women, improve men’s HIV-related health outcomes and achieve the UNAIDS 95-95-95 goals by 2030. In this study, we evaluate the effectiveness of Undetectable Equals Untransmittable or “U=U” messaging for closing the gender gap in the HIV cascade. The U=U message communicates the compelling idea that PLHIV who take ART and have an undetectable viral load (<200 copies/mL) cannot sexually transmit HIV. Particularly for men, the U=U message has the potential to accelerate progress towards the 95-95-95 targets by: 1) reducing anxiety associated with HIV testing (1st 95); 2) encouraging people who test HIV-positive to initiate ART (2nd 95); and 3) reducing fear of transmitting HIV to sexual partners by promoting treatment adherence to achieve viral suppression (3rd 95). While there is a growing knowledge of Treatment as Prevention (TasP)/U=U among PLWH in Western countries, the reach and penetration of the U=U message in sub-Saharan Africa has been limited and few studies have tested the impacted of accessible U=U messages on ART uptake and adherence in sub-Saharan Africa. Building on our prior work on U=U messaging informed by behavioral economics and human-centered design, we propose to conduct two hybrid type 1 effectiveness-implementation randomized controlled trials to evaluate the impact of U=U messages on men’s uptake of community-based HIV testing and treatment initiation (Aim 1), and achievement of viral suppression (Aim 2). We will also conduct a multi-method evaluation to inform future implementation of U=U messaging interventions. To improve the generalizability of our findings, we will conduct our study in two provinces in South Africa (Western and Eastern Cape). If effective, our intervention can shape global HIV testing and treatment counselling guidelines and practices. Our expert, multi-institutional collaborations will allow us to apply previous research findings, leverage unique implementation platforms and resources, and rapidly disseminate our findings.

项目摘要 增加艾滋病毒（PLHIV）患者中艾滋病毒测试和治疗的覆盖范围对于 结束全球艾滋病流行。不幸的是，与女性相比，患有艾滋病毒（MLHIV）的男性少 可能了解其HIV状况，开始抗逆转录病毒治疗或获得病毒抑制。鉴于新的艾滋病毒 女性的感染部分是通过男性的测试和治疗差距驱动的，从而减少了性别差距 必须优先考虑测试摄取，治疗计划和男性抑制病毒抑制 加速女性艾滋病毒事件的下降，改善男性与艾滋病毒相关的健康成果并实现 到2030年，UNAIDS 95-95-95目标。在这项研究中，我们评估了无法检测到的有效性 无法转换或“ U = U”消息传递，以缩小HIV级联中的性别差距。 u = u消息 传达了令人信服的想法，即plhiv服用艺术并具有无法检测的病毒载荷（<200 副本/ml）不能对艾滋病毒进行性传播。特别是对于男性，u = u消息有可能加速 朝着95-95-95目标的进展：1）减少与HIV测试相关的动画（1st 95）； 2）鼓励 测试HIV阳性以发起艺术的人（第二95）； 3）减少对将艾滋病毒传播给性伴侣的恐惧 通过促进治疗依从性以实现病毒抑制（第395页）。虽然对 在西方国家的PLWH中作为预防（TASP）/U = U的治疗，U = U的覆盖范围和渗透 撒哈拉以南非洲的消息受到限制，很少有研究测试了可访问的U = U的影响 撒哈拉以南非洲的艺术吸收和依从性信息。在我们先前在u = u消息传递的工作的基础上 通过行为经济学和以人为本的设计，我们建议进行两种混合型1 有效性实施随机对照试验，以评估U = U消息对男性的影响 采用基于社区的艾滋病毒测试和治疗计划（AIM 1），并实现病毒抑制 （目标2）。我们还将进行多方法评估，以告知U = U消息传递的未来实施 干预措施。为了提高发现结果的普遍性，我们将在南方的两项规定中进行研究 非洲（西开普省）。如果有效，我们的干预措施可以塑造全球HIV测试和治疗 咨询指南和实践。我们的专家，多机构合作将使我们能够应用以前的 研究发现，利用独特的实施平台和资源，并迅速传播我们的 发现。