Community-Based HIV VCT: South Africa

基于社区的 HIV VCT：南非

• 批准号: 7089067
• 负责人: Thomas J. Coates
• 金额: $ 314.5万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7089067
• 关键词: AIDS /HIV test; AIDS education /prevention; Africa; HIV infections; adolescence (12-20); attitude; behavior modification; behavioral /social science research tag; clinical research; community; cooperative study; cost effectiveness; counseling; disease /disorder prevention /control; human subject; medical outreach /case finding; outcomes research; southeast Asia; young adult human (21-34)

DESCRIPTION (provided by applicant): From a public health perspective, there is no more compelling crisis in the world today than the HIV epidemic in the developing world. This is a Phase III community-level randomized controlled study, in which 32 communities in Africa (Tanzania, Zimbabwe, and South Africa) and 14 communities in Thailand will be randomized to either a community-based HIV voluntary counseling and testing (CBVCT) intervention or clinic-based standard VCT (SVCT). The CBVCT intervention has three major strategies: (1) to make VCT more available in community settings; (2) to engage the community through outreach; and (3) to provide post-test support. These three strategies are designed to change community norms and reduce risk for HIV infection among all community members, irrespective of whether they participated directly in the intervention. Thus, a community-level sampling approach as opposed to a cohort design is used to evaluate outcomes. The primary aim (Aim 1) is to test the hypothesis that communities receiving 2-1/2 years of CBVCT, relative to communities receiving 2-1/2 years of SVCT, will have significantly lower prevalence of recent HIV infection. In addition, we propose the following secondary aim (Aim 2) to test the hypotheses that CBVCT communities, relative to SVCT communities, will at the end of the intervention period report significantly: a) less HIV risk behavior; b) higher rates of HIV testing; c) more favorable social norms regarding HIV testing; d) more frequent discussions about HIV; e) more frequent disclosure of HIV status; f) less HIV-related stigma; and g) less HIV-related social harm. Finally, because of the importance of cost-effectiveness data to host and donor countries, we propose to assess (Aim 3) the incremental cost-effectiveness of CBVCT compared to SVCT. A random sample of persons between the ages of 18 and 32 years of age from each community will be selected at baseline and post-intervention for measuring primary and secondary endpoints. Aim 1 will be evaluated by comparing the post-intervention prevalence of recent infection measured by the sensitive/less sensitive HIV assay on all positive HIV blood samples in the two arms of the study. Aim 2 will be evaluated by comparing a variety of behavioral measures at baseline and post-intervention. Aim 3 will be evaluated in terms of cost per HIV infection averted and disability-adjusted life years saved.

描述（由申请人提供）：从公共卫生的角度来看，当今世界没有比发展中国家的艾滋病毒流行更引人注目的危机了。这是一项 III 期社区级随机对照研究，其中非洲 32 个社区（坦桑尼亚、津巴布韦和南非）和泰国 14 个社区将被随机分配接受基于社区的 HIV 自愿咨询和检测 (CBVCT) 干预或基于临床的标准 VCT (SVCT)。 CBVCT 干预有三大策略：(1) 使 VCT 在社区环境中更容易获得； (2) 通过外展活动吸引社区参与； (3) 提供测试后支持。这三项策略旨在改变社区规范并降低所有社区成员感染艾滋病毒的风险，无论他们是否直接参与干预。因此，使用社区层面的抽样方法而不是队列设计来评估结果。 主要目的（目标 1）是检验以下假设：相对于接受 2-1/2 年 SVCT 的社区，接受 2-1/2 年 CBVCT 的社区近期 HIV 感染率将显着降低。此外，我们提出以下次要目标（目标 2）来检验 CBVCT 社区相对于 SVCT 社区在干预期结束时将显着报告的假设： a) 减少 HIV 危险行为； b) 更高的艾滋病毒检测率； c) 关于艾滋病毒检测更有利的社会规范； d) 更频繁地讨论艾滋病毒； e) 更频繁地披露艾滋病毒状况； f) 减少与艾滋病毒相关的耻辱； g) 减少与艾滋病毒相关的社会危害。最后，由于成本效益数据对东道国和捐助国的重要性，我们建议评估（目标 3）CBVCT 与 SVCT 相比的增量成本效益。 将在基线和干预后从每个社区随机选择年龄在 18 岁至 32 岁之间的人员样本，以测量主要和次要终点。目标 1 将通过比较干预后最近感染的患病率来评估，该患病率是通过对研究的两个臂中所有阳性 HIV 血液样本进行敏感/不太敏感的 HIV 检测来测量的。将通过比较基线和干预后的各种行为测量来评估目标 2。目标 3 将根据避免每次艾滋病毒感染的成本和节省的伤残调整生命年进行评估。