Intervention for Sustained Testing and Retention (iSTAR) Among HIV-infected Patients

HIV 感染者持续检测和保留干预 (iSTAR)

基本信息

批准号：
9337549
负责人：
Echezona Edozie Ezeanolue
金额：
$ 25.5万
依托单位：
UNIVERSITY OF NEVADA LAS VEGAS
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-02 至 2018-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9337549
关键词：
15 year old Accounting Acquired Immunodeficiency Syndrome Address Africa South of the Sahara Attitude B-Lymphocytes Behavior California Caring Case Management Chicago Child Childhood Church Clergy Climate Clinic Clinical Cluster randomized trial Collaborations Communities Continuity of Patient Care Control Groups Country Development Diagnosis Educational Intervention Effectiveness Effectiveness of Interventions Evaluation Female of child bearing age Funding Funding Agency Generations Genotype Goals HIV HIV Infections HIV diagnosis Health Hepatitis B Human immunodeficiency virus test Individual Infant Infection Institution Intervention Laboratories Leadership Life Link Maintenance Mediation Methods Mother-to-child HIV transmission Nevada Nigeria Outcome Participant Pathway Analysis Patients Perception Phase Policy Maker Pregnancy Pregnant Women Preparation Prevention Prevention program Randomized Resources Risk Sickle Cell Site Social Network Staging Testing Training Treatment Cost Universities Viral Viral Load result Woman antiretroviral therapy base care delivery cohesion college comparative effectiveness design education access effectiveness trial follow-up implementation science motivational enhancement therapy primary outcome programs retention rate secondary outcome skills social stigma trial design

项目摘要

DESCRIPTION (provided by applicant): Globally, Nigeria has the 2nd largest number of: a) people living with HIV, b) new HIV infections, and c) pregnant women living with HIV. In 2013 only 17.1% of women of childbearing age 15-49 years received an HIV test (preceding 12-months) and only 27% of the estimated 190,000 HIV-infected pregnant women in Nigeria who delivered babies received antiretroviral therapy for prevention of mother-to-child HIV transmission (PMTCT), compared to 68% of pregnant women receiving ART overall in sub-Saharan Africa (SSA). Nigeria accounts for 25% of new childhood HIV infections among the 21 priority countries (estimated 51,000 new infections). Roughly 49% of HIV-infected pregnant women in SSA are lost to follow up between registration in antenatal care and delivery, and 45% of infants are lost after HIV testing. Nigeria has high loss to follow-up (15%-56%) among HIV-infected women and children. In 2014, we demonstrated that the Healthy Beginning Initiative (HBI), a congregation-based intervention delivered by church-based health teams, was more effective in increasing HIV testing among pregnant women compared to a clinic-based approach. HBI uses church organized baby showers to engage and identify women early in pregnancy, combines educational intervention with integrated, on-site laboratory testing designed to reduce stigma associated with HIV-only testing. Baby receptions facilitate post-delivery follow-up and linkage to care. HBI addresses several barriers to HIV testing: perception of low risk to infection (education), access to testing and treatment, and cost and stigma (on-site, free, integrated testing). At least one faith-based institution is in each community, presenting a unique opportunity to evaluate the effectiveness of iSTAR, an integrated community and clinic based intervention that is designed to test, link, engage and sustain HIV-infected women in care. We propose a cluster randomized comparative effectiveness trial of iSTAR versus a clinic-based approach (CG). We will assess linkage, engagement, retention and viral suppression among 400 HIV-infected women. Based on the EPIS framework, we will use social network intervention methods to facilitate implementation and also assess implementation leadership and context. Fifty churches in south-south Nigeria will be randomly assigned (1:1) to iSTAR or CG. The iSTAR intervention provides: confidential, onsite integrated laboratory testing during baby showers; a network of church-based health advisors; clinic based teams trained in motivational interviewing; quality improvement skills to engage and support HIV-infected women; and integrated case management to reduce loss to follow-up. Primary outcomes are difference in linkage and engagement rates between iSTAR and CG. Secondary outcomes are difference in retention and viral suppression rate. This proposal is a collaboration among University of Nigeria (PEPFAR-funded partner in Nigeria [training and local project oversight]; University of Southern California (network analysis); UC San Diego (implementation science); UIC Chicago (assessment of sustainment); Nevada State College (statistical analyses and mediation/moderation analysis), and University of Nevada, Las Vegas (overall oversight of program implementation and evaluation).

描述（由适用提供）：在全球范围内，尼日利亚拥有第二大数量：a）患有艾滋病毒的人，b）新的艾滋病毒感染和c）患有艾滋病毒的孕妇。 2013年，只有15-49岁的育龄妇女中，只有17.1％接受了艾滋病毒测试（在12个月之前），而尼日利亚估计有190,000名艾滋病毒感染的孕妇的估计为190,000名艾滋病毒感染的孕妇接受了抗逆转录病毒疗法，以预防母亲到童伤艾滋病毒传播（PMTCT），与68％的孕妇相比，对孕妇的孕妇进行了比较，孕妇的孕妇是孕妇的孕妇。尼日利亚占21个优先国家中新儿童艾滋病毒感染的25％（估计有51,000个新感染）。 SSA中大约有49％的HIV感染孕妇丢失了在静脉护理和分娩中的注册之间进行跟进，而在HIV检查后，有45％的婴儿丢失了。尼日利亚在HIV感染的妇女和儿童中遭受了很高的随访（15％-56％）。 2014年，我们证明，与基于诊所的方法相比，基于教会的健康团队提供的健康开始计划（HBI）在基于教会的健康团队提供的基于会众的干预措施中更有效地增加了孕妇的艾滋病毒测试。 HBI使用教会有组织的婴儿淋浴在怀孕初期参与和识别妇女，将教育干预与综合的现场实验室测试相结合，旨在减少与仅与HIV的测试相关的污名。婴儿招待会有助于保存后的随访和关联。 HBI解决了艾滋病毒测试的几个障碍：对感染的低风险感知（教育），接受测试和治疗以及成本和污名（现场，免费，综合测试）。每个社区中至少有一个基于信仰的机构，为评估ISTAR的有效性提供了一个独特的机会，ISTAR是一种基于综合的社区和诊所的干预措施，旨在测试，联系，参与和维持护理中的HIV感染妇女。我们提出了ISTAR与基于诊所的方法（CG）的簇随机比较有效性试验。我们将评估400名HIV感染妇女的联系，参与，保留和病毒抑制。根据EPIS框架，我们将使用社交网络干预方法来促进实施以及评估实施领导和环境。尼日利亚南南的五十个教堂将被随机分配（1：1）到Istar或CG。 ISTAR干预提供：在婴儿淋浴期间，自信的现场集成实验室测试；一个基于教会的健康顾问网络；受诊所的团队接受了励志面试的培训；质量改进技能，以吸引和支持感染HIV的妇女；并集成案件管理以减少随访的损失。主要结果是ISTAR和CG之间的联系和参与率的差异。次要结果是保留率和病毒抑制率的差异。该提案是尼日利亚大学（尼日利亚的PEPFAR资助的合作伙伴[培训和本地项目监督]；南加州大学；网络分析）； UC圣地亚哥大学； UC San Diego（实施科学）； UIC芝加哥（UIC Chicago）（维持维持）；内华达州立大学（NEVADA State）；内华达州立大学（统计分析/中介分析分析），以及NEVADA，LAS VEGAS，LAS VEGAS，总体而言）。