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: 8447165
• 负责人: CONNIE L CELUM
• 金额: $ 115.92万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8447165
• 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; Stigmata; 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; public health relevance; 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. PUBLIC HEALTH RELEVANCE: HBCT-plus is a home-based HIV testing program in Uganda to increase knowledge of HIV+ status with associated behavior change, and reduce HIV infectiousness through effective linkages to antiretroviral therapy and treatment of co-infections, and assessed by reduction in community viral load and transmission potential.

描述（由申请人提供）：本申请，减少乌干达艾滋病毒感染性的干预措施，对全球健康主题中NIH导演的研究机会（RC-4）做出了回应。需要采取新颖的，具有成本效益的策略，以有效地在非洲提供验证的艾滋病毒预防和治疗服务，以对人群艾滋病毒发病率产生重大影响。我们认为，通过对艾滋病毒+人的艾滋病毒预防和护理服务的靶向人群介绍，可以通过增加对艾滋病毒+状态的知识以及相关行为改变的知识，并通过抗逆转录病毒治疗（ART）来降低HIV感染性，以及对诸如疟疾等共同感染的预防和治疗。 HBCT HBCT以家庭为基础的HIV咨询和测试计划已获得了对HIV血清的大规模知识。我们将在HBCT平台（“ HBCT-Plus”）上建立针对HIV+人的有针对性，预防和治疗服务，以减少HIV感染性，这将增加我们在乌干达的预防计划项目（MP-3）研究。我们将在乌干达的高艾滋病毒患病率领域的5000户家庭中实施HBCT-Plus，并遵循乌干达的指南，预防和治疗所有HIV+人的共同感染。我们将提供预防措施降低风险咨询和不和谐的夫妻咨询，以减少风险行为。我们将进行一年的季度随访，以优化临床干预措施的吸收并评估风险行为和污名。 HBCT-Plus成功的措施将对：1）社区病毒负荷（在12个月内的平均HIV血浆病毒载荷），人口水平的HIV感染性的标志，以及2）HIV传播潜力，一种与HIV或未知患者的HIV+人的病毒载荷和性行为的综合度量，具有HIV或不知名的Serostatus Partners，他们对HIV的影响很大。具体目的：1）表现出HBCT-Plus的可行性，通过HIV测试，POC CD4测试对HIV+人进行护理以及预防效果和不一致的情侣咨询，并在一年中提供了乌干达的5000户家庭，基于> 90％的测试和> 80％的链接和> 80％的Linkage to Care in> 80％的HHIV+ Persons。 2）通过评估HBCT-Plus之前和之后的社区病毒载荷和HIV传播潜力，衡量HBCT-Plus对艾滋病毒传播风险的影响。 3）衡量向伴侣和家人披露，伴侣的艾滋病毒测试，使用避孕套，性频率以及通过HBCT-Plus为新认同的HIV+患者进行积极预防咨询之前和之后的伴侣数量。 4）通过在社区中的概率样本调查中评估HBCT-Plus对社区风险行为，对HIV测试的态度以及污名的影响。 5）确定HBCT的增量成本和HBCT加的其他组成部分，以促进HIV护理和咨询，并估算降低社区病毒负荷的成本效益。 公共卫生相关性：HBCT-Plus是乌干达的一项家庭艾滋病毒测试计划，可通过有效与抗逆转录病毒治疗和治疗共同感染的有效联系来提高对艾滋病毒+状态的知识，并降低艾滋病毒感染力，并通过减少社区病毒负荷和传播潜力来评估。