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 乌干达的艾滋病毒负担在全球排名第五，也是非洲生育率最高的国家之一。 母婴传播选项 B+ (PMTCT B+) 是乌干达的国家政策，旨在最大限度地预防母婴传播。 PMTCT B+ 的临床益处、男性伴侣 HIV 检测率低的挑战以及高感染率 产时停止抗逆转录病毒治疗 (ART)、ART 依从性不足和病毒感染不完全 女性可能更有可能长期继续接受抗逆转录病毒疗法，并且有更高的生存率。 如果他们的伴侣接受了检测、相互披露了艾滋病毒状况以及他们的伴侣，则产后依从性 接受 ART 或 PrEP，具体取决于伴侣的状况，需要创新的方法来允许男性进行测试。 在繁忙的产前诊所的替代环境中，最好是在私人的地方，让他们感到舒适并且不会错过 我们将使用创新技术——艾滋病毒自检（HIVST）和暴露前预防（PrEP）——来开展工作。 增加男性伴侣对艾滋病毒检测、预防和护理服务的参与。我们将对孕妇进行培训。 在 HIVST 的使用和解释中，为他们提供两种基于口腔液的 HIVST 试剂盒，以便与他们一起使用或给予 我们将为男性提供确认性检测、咨询，如果呈阴性，则提供 PrEP，如果呈阳性，则提供 ART。 将为 HIV 阴性男性伴侣提供咨询，以尽量减少 HIV 自我检测的社会危害。 阳性孕妇在重要的“危险季节”提供了有效的干预措施，此时她们可能 通过其他伴侣或当他们的伴侣可能患有病毒血症时（在感染后的最初几个月内）有额外的风险 ART 启动、产后 ART 终止或由于病毒耐药）.. 综合 PrEP 和 ART 交付 在东非 HIV 血清不一致的夫妇中进行的一项研究表明，PrEP 是直到 HIV 阳性伴侣出现之前的一座“桥梁” 接受 ART 六个月是非常可以接受的，对 ART 和 PrEP 的接受度和依从性非常高， 我们将使用 HIVST 来识别 HIV 血清不一致的夫妇并进行调整。 PrEP 与乌干达 PMTCT B+ 计划的衔接策略，以增加产后 ART 的持续性 目标 1：确定乌干达加强的 PMTCT 计划是否能够实现这一目标。 为男性伴侣提供 HIV 自我检测，并为 HIV 阴性男性提供 PrEP，提高了 进行 HIV 检测并启动 PrEP 的男性 目标 2：评估是否使用 HIV 检测、PrEP 和 ART。 男性伴侣的参与提高了乌干达艾滋病毒感染妇女产后抗逆转录病毒治疗的有效使用 PMTCT B+ 目标 3：评估 PMTCT 孕妇对 HIV 自我检测和 PrEP 的可接受性 B+和他们的男性伴侣，使用定性和定量的方法 总之，这个项目将。 通过评估增加男性伴侣的创新策略，解决 PMTCT B+ 计划中的主要挑战 参与 PMTCT B – HIVST，以克服男性不愿检测和“通过代理”进行检测的倾向， 同时为 HIV 阴性男性提供 PrEP，为 HIV 阳性男性提供 ART，并鼓励产后 ART 艾滋病毒呈阳性的妇女的继续和坚持。