Interventions to decrease HIV infectiousness in Uganda

降低乌干达艾滋病毒感染率的干预措施

• 批准号: 8722105
• 负责人: CONNIE L CELUM
• 金额: $ 51.37万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-19 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8722105
• 关键词: AIDS prevention; Africa; Area; Attitude; Behavioral; Caring; Clinical; Clinical Services; Communities; Costs and Benefits; Counseling; Couples; Diagnostic; Disclosure; Epidemic; Epidemiology; Family; Frequencies; Funding; Guidelines; HIV; Home environment; Household; Human immunodeficiency virus test; Incidence; Infection; Intervention; Knowledge; Learning; Malaria; Measures; Methods; Modeling; Persons; Plasma; Population; Prevalence; Prevention; Prevention Guidelines; Prevention program; Preventive; Preventive Intervention; Probability Samples; Research; Risk; Risk Behaviors; Risk Reduction; Services; Sex Behavior; Surveys; Target Populations; Testing; Triage; Uganda; United States National Institutes of Health; Viral Load result; Visit; antiretroviral therapy; base; behavior change; condoms; cost; cost effective; design; evidence base; follow-up; global health; men; novel; point of care; programs; response; scale up; social stigma; success; transmission process; uptake

DESCRIPTION (provided by applicant): This application, Interventions to decrease HIV infectiousness in Uganda, responds to the NIH Director's Opportunity for Research (RC-4) within the Global Health theme. Novel, cost-effective strategies are needed to efficiently deliver proven HIV prevention and treatment services in Africa to have a substantial impact on population HIV incidence. We posit that HIV transmission in a community can be reduced through targeted, population-level delivery of HIV prevention and care services to HIV+ persons, through increasing knowledge of HIV+ status with associated behavior change and reducing HIV infectiousness through initiation of antiretroviral therapy (ART), and prevention and treatment of co-infections such as malaria. Home-based HIV counseling and testing programs, HBCT, have achieved large scale knowledge of HIV serostatus. We will build on the HBCT platform ("HBCT-plus") with targeted diagnostic, preventive, and treatment services for HIV+ persons and behavioral counseling to reduce HIV infectiousness, which will augment our Methods of Prevention Program Project (MP-3) research in Uganda. We will implement HBCT-plus in 5000 households in a high HIV prevalence area in Uganda with point-of-care (POC) CD4 testing to triage HIV+ persons to ART following Uganda guidelines and prevention and treatment of co-infections for all HIV+ persons. We will deliver prevention-for-positives risk-reduction counseling and discordant couples counseling to reduce risk behaviors. We will conduct quarterly follow-up visits for one year to optimize uptake of clinical interventions and to assess risk behaviors and stigma. Measures of success of HBCT-plus will be impact on: 1) community viral load (average HIV plasma viral load in the community over 12 months), a marker of population-level HIV infectiousness, and 2) HIV transmission potential, a composite measure of viral load and sexual behavior among HIV+ persons with HIV- or unknown serostatus partners, who have the greatest impact on HIV spread. Specific Aims: 1) Demonstrate feasibility of HBCT-plus, with HIV testing, POC CD4 testing to triage HIV+ persons to care, and prevention-for-positives and discordant couples counseling, delivered to 5000 households in Uganda in one year, based on >90% uptake of testing and >80% linkage to care among HIV+ persons. 2) Measure the impact of HBCT-plus on HIV transmission risk in the community through assessment of community viral load and HIV transmission potential before and after HBCT- plus. 3) Measure disclosure to partners and family, HIV testing of partners, condom use, sexual frequency, and number of partners before and after positive prevention counseling for newly-identified HIV+ persons through HBCT-plus. 4) Evaluate the effect of HBCT-plus on community risk behaviors, attitudes about HIV testing, and stigma through a probability sample survey in the community. 5) Determine the incremental costs of HBCT and additional components in HBCT-plus for facilitated HIV care and counseling, and estimate the cost-benefit of community viral load reduction.

描述（由申请人提供）：本申请《降低乌干达艾滋病毒传染性的干预措施》响应了 NIH 主任在全球健康主题范围内的研究机会 (RC-4)。需要采取新颖、具有成本效益的战略，在非洲有效提供行之有效的艾滋病毒预防和治疗服务，从而对人口艾滋病毒发病率产生重大影响。我们认为，可以通过以下方式减少社区中艾滋病毒的传播：向艾滋病毒阳性者提供有针对性的人口层面的艾滋病毒预防和护理服务，通过增加对艾滋病毒+状况的了解以及相关的行为改变，并通过启动抗逆转录病毒治疗（ART）来减少艾滋病毒传染性，以及疟疾等合并感染的预防和治疗。家庭艾滋病毒咨询和检测项目 HBCT 已经实现了对艾滋病毒血清状态的大规模了解。我们将在 HBCT 平台（“HBCT-plus”）的基础上，为 HIV + 患者提供有针对性的诊断、预防和治疗服务，并提供行为咨询，以减少 HIV 传染性，这将增强我们在以下领域的预防方法计划项目 (MP-3) 研究：乌干达。我们将在乌干达艾滋病毒高发地区的 5000 个家庭实施 HBCT-plus，并按照乌干达指南以及对所有艾滋病毒感染者的合并感染进行预防和治疗，通过即时护理 (POC) CD4 检测将艾滋病毒感染者分流至接受抗逆转录病毒治疗。我们将提供以预防为主的风险降低咨询和不和谐夫妻咨询，以减少风险行为。我们将进行为期一年的季度随访，以优化临床干预措施的采用并评估风险行为和耻辱感。 HBCT+ 成功的衡量标准将影响：1) 社区病毒载量（12 个月内社区中的平均 HIV 血浆病毒载量），人口水平 HIV 传染性的标志，以及 2) HIV 传播潜力，一项综合衡量指标艾滋病病毒感染者与艾滋病病毒感染者或血清状态未知的伴侣​​之间的病毒载量和性行为，这些人对艾滋病毒传播的影响最大。具体目标： 1) 证明 HBCT-plus 的可行性，包括 HIV 检测、POC CD4 检测以对 HIV+ 患者进行分类以进行护理，以及针对阳性和不和谐夫妇的预防咨询，在一年内向乌干达 5000 个家庭提供，基于 > HIV+ 患者中 90% 的检测率和 80% 以上的护理联系率。 2) 通过评估HBCT+前后的社区病毒载量和HIV传播潜力，衡量HBCT+对社区HIV传播风险的影响。 3) 衡量对伴侣和家人的披露情况、伴侣的 HIV 检测、安全套使用情况、性行为频率以及通过 HBCT-plus 对新发现的 HIV + 患者进行积极预防咨询前后的伴侣数量。 4）通过社区概率抽样调查，评估HBCT+对社区危险行为、对HIV检测的态度和耻辱感的影响。 5) 确定 HBCT 和 HBCT-plus 中用于促进艾滋病毒护理和咨询的其他组成部分的增量成本，并估计社区病毒载量减少的成本效益。