HIV self-testing and PrEP to increase testing and prevention uptake among male partners and improve postpartum ART use in PMTCT B+ programs in Uganda

HIV 自我检测和 PrEP 可提高男性伴侣的检测和预防接受率，并改善乌干达 PMTCT B 项目中产后 ART 的使用

• 批准号: 9895861
• 负责人: CONNIE L CELUM
• 金额: $ 65.52万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-10 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895861
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Africa; African; Caring; Clinic; Clinical; Communicable Diseases; Counseling; Country; Coupled; Couples; Disclosure; Effectiveness; Fertility Rates; Generations; HIV; HIV Seronegativity; HIV Seropositivity; Hospitals; Human immunodeficiency virus test; Infection; Institutes; Intervention; Interview; Kenya; Letters; Link; Liquid substance; Methods; Oral; Outcome; Persons; Policies; Postpartum Period; Postpartum Women; Pregnant Women; Prevention; Provider; Proxy; Questionnaires; Randomized; Risk; Seasons; Standardization; Testing; Time; Training; Travel; Uganda; Universities; Vertical Disease Transmission; Viral; Viral Load result; Woman; Work; antenatal; antiretroviral therapy; base; care systems; cost; effective intervention; improved; improved outcome; innovation; innovative technologies; male; men; perinatal HIV; pre-exposure prophylaxis; pregnant; prevention service; primary outcome; programs; social; standard of care; testing services; therapy adherence; transmission process; uptake; viral resistance

ABSTRACT Uganda has the fifth highest HIV burden globally and one of the highest fertility rates in Africa. Prevention of mother-to-child transmission Option B+ (PMTCT B+) is national policy in Uganda. To maximize the prevention and clinical benefits of PMTCT B+, the challenges of low HIV testing by male partners and high rates of post- partum discontinuation of antiretroviral therapy (ART), insufficient ART adherence, and incomplete viral suppression need to be addressed. Women may be more likely to continue ART long-term and have higher adherence post-partum if their partners are tested, there is mutual disclosure of HIV status, and their partner takes ART or PrEP, depending on the partner’s status. Innovative approaches are needed to allow men to test in alternative settings to busy antenatal clinics, preferably privately where they are comfortable and do not miss work. We will use innovative technologies – HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP) – to increase male partners’ engagement in HIV testing, prevention, and care services. We will train pregnant women in the use and interpretation of HIVST, provide them with two oral fluid-based HIVST kits to use with or give to their partners. We will offer men confirmatory testing, counseling, and if negative, PrEP and if positive, ART. We will provide counseling to minimize social harms of HIV self-testing. PrEP for HIV-negative male partners of HIV- positive pregnant women provides an effective intervention during an important ‘season of risk’ when they may have additional risk through other partners or when their partner may be viremic (during the first few months after ART initiation, post-partum ART discontinuation or due to viral resistance).. Integrated PrEP and ART delivery among East African HIV serodiscordant couples showed that PrEP as a ‘bridge’ until the HIV-positive partner was on ART for six months was very acceptable, achieved very high uptake and adherence to ART and PrEP, and nearly eliminated HIV transmission. We will use HIVST to identify HIV serodiscordant couples, and adapt the PrEP bridging strategy to Ugandan PMTCT B+ programs to increase ART continuation post-partum for clinical and prevention benefits. Aim 1: Determine whether an enhanced PMTCT program in Uganda that provides HIV self-testing for male partners and PrEP for HIV-negative men increases the proportion of men who test for HIV and initiate PrEP. Aim 2: Evaluate whether HIV testing and PrEP and ART use among male partners increases effective post-partum ART use among HIV-infected Ugandan women in PMTCT B+. Aim 3: Assess the acceptability of HIV self-testing and PrEP to pregnant women in PMTCT B+ and to their male partners, using qualitative and quantitative methods. In summary, this project will address key challenges in PMTCT B+ programs, by evaluating innovative strategies to increase male partner involvement in PMTCT B – HIVST to overcome men’s reluctance to test and their tendency to test ‘by proxy,’ coupled with offering PrEP to HIV-negative men, ART to HIV-positive men, and encouraging post-partum ART continuation and adherence among HIV-positive women.

抽象的 乌干达在全球拥有第五大艾滋病毒，是非洲最高的生育率之一。预防 母子传播选项B+（PMTCT B+）是乌干达的国家政策。最大化预防 以及PMTCT B+的临床益处，男性伴侣低艾滋病毒测试的挑战以及高率的后 抗逆转录病毒疗法（ART）的局部停用，艺术依从性不足和病毒不完全 抑制需要解决。妇女可能更有可能长期继续艺术，并且具有更高的 依从后，如果对他们的伴侣进行了测试，则艾滋病毒状况相互披露及其伴侣 根据伴侣的身份进行艺术或准备。需要创新的方法来允许男人进行测试 在繁忙的天线诊所的其他设置中 工作。我们将使用创新技术 - 艾滋病毒自我测试（HIVST）和暴露前预防（PREP） - 增加男性伴侣参与艾滋病毒测试，预防和护理服务。我们将培训孕妇 在HIVST的使用和解释中，为他们提供两个基于口服流体的HIVST套件可用于或给予或给予 他们的伴侣。我们将提供男性确认测试，咨询，以及如果否定，准备，如果是积极的，则为艺术。我们将提供男性确认测试，咨询，以及如果否定，准备，如果是积极的，则为艺术。 将提供咨询，以最大程度地减少艾滋病毒自我测试的社会危害。为HIV的HIV阴性男性伴侣做准备 积极的孕妇在重要的“风险季节”中提供有效的干预措施 通过其他伴侣或伴侣可能患有病毒的额外风险（在此之后的头几个月 艺术倡议，后方艺术中止或由于病毒抗性）。 在东非艾滋病毒的伴侣夫妇中，在艾滋病毒阳性伴侣之前，预备是“桥梁” 在艺术上六个月非常可以接受，获得了很高的吸收和遵守艺术和准备， 几乎消除了艾滋病毒的传播。我们将使用HIVST识别HIV Serodiscordant夫妇，并适应 乌干达PMTCT B+计划的准备桥梁策略，以增加艺术的延续后果 临床和预防益处。目标1：确定乌干达增强的PMTCT计划是否 为男性伴侣提供艾滋病毒自我测试，并为艾滋病毒阴性男性做好准备 测试艾滋病毒并启动准备的男性。目标2：评估艾滋病毒测试，准备和艺术是否使用 在男性伴侣中，在艾滋病毒感染的乌干达妇女中增加了有效的产后艺术使用 PMTCT B+。 AIM 3：评估PMTCT中艾滋病毒自我测试的可接受性和对孕妇的准备 B+和他们的男性伴侣，使用定性和定量方法。总而言之，这个项目将 通过评估创新策略以增加男性合作伙伴，应对PMTCT B+计划中的主要挑战 参与PMTCT B - HIVST，以克服男性不愿进行测试及其“通过代理”测试的趋势 再加上为艾滋病毒阴性男人提供准备 艾滋病毒阳性妇女的持续和依从性。