Impact of Integrated HIV/NCD Screening on HIV Testing Uptake and Engagement in HIV Care: an RCT in Kisarawe, Tanzania

艾滋病毒/非传染性疾病综合筛查对艾滋病毒检测的采用和参与艾滋病毒护理的影响：坦桑尼亚基萨拉韦的随机对照试验

• 批准号: 9750110
• 负责人: Michael D Sweat
• 金额: $ 60.99万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-15 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9750110
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Africa South of the Sahara; Awareness; Blood Glucose; Blood Pressure; Caring; Catchment Area; Censuses; Characteristics; Client; Clinic; Clinical; Communities; Consult; Counseling; Country; Data; Diabetes Mellitus; Dropout; Enrollment; Epidemic; Expenditure; Failure; Fatigue; Glycosylated hemoglobin A; Goals; HIV; HIV Infections; Health; Health Benefit; Household; Human immunodeficiency virus test; Hypertension; Incidence; Individual; Infection; Intervention; Investments; Knowledge; Lead; Life; Medical; Patients; Pattern; Persons; Pilot Projects; Policies; Population; Prediabetes syndrome; Prevention; Probability; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recording of previous events; Sampling; Savings; Services; Site; Stigmatization; System; Tanzania; Testing; Time; Viral; Visit; antiretroviral therapy; base; burden of illness; care costs; clinically significant; cohort; community setting; cost; cost effective; cost effectiveness; design; diabetes control; efficacy testing; experience; hypertension control; hypertension treatment; improved; interest; low and middle-income countries; novel; prehypertension; prevent; programs; rural area; screening; social stigma; transmission process; treatment center; treatment program; trend; uptake

PROJECT SUMMARY / ABSTRACT HIV testing is often shunned in community settings due to the stigma of HIV-centric services. Our recent pilot study strongly suggest that integration of a package of screening that include HIV, diabetes, and hypertension hold promise of substantially increasing the uptake of HIV testing while simultaneously providing direly needed community screening for non-communicable disease (NCDs) like diabetes and hypertension, which themselves are at epidemic levels in Sub-Saharan Africa. In our pilot study we found that HIV testing almost doubled when diabetes and hypertension screening was added. Moreover, once HIV-infected individuals are identified, many are reluctant to enter care due to the stigma of HIV-centric care programs, and over time attrition of clients is a serious problem undermining the clinical and public health benefits of these programs. Our preliminary studies strongly suggest that integration of NCD care within HIV care would increase enrollment and retention in HIV care by destigmatizing the clinics for all attendees, and by providing tangible clinical therapies for the estimated 79% of HIV-infected clients who also have NCDs, especially those waiting to become eligible for ART, who are also those with the highest attrition. We will assess: (a) the client characteristics and patterns of utilization at the 6 HIV Care and Treatment Centers (CTCs) in Kisarawe District, Tanzania; (b) trends in HIV testing; (c) history of HIV intervention (d) census data; (e) conduct community mapping in each CTC’s catchment area; (f) consult with community leaders and Medical Officers , and (g) match two similar CTCs . Next, one of the two CTCs will be randomized as an enhanced intervention site. At both CTCs we will conduct community mobilization to alert community of available services. At the enhanced intervention CTC we will also provide screening for diabetes and hypertension. The Health Center (always adjacent to the CTC) will be assisted with treating positive NCD cases. HIV-infected clients will be referred to the CTC at both sites, and the first 89 patients at each CTC will be enrolled in a cohort and followed for 24- months (total N=178 across 2 clinics). Those in the cohort at the enhanced intervention CTC who are NCD positive will have care for NCDs integrated with their HIV care. We will assess how NCD screening affects uptake of HIV testing at the community-level over ~18-months. We will establish whether adding NCD care to HIV care improves linkage and enrollment in HIV care. We will determine if retention in HIV care among newly enrolled clients is enhanced over 24-months with the addition of NCD care. We will then cost all intervention components to determine the incremental cost per added client tested for HIV, enrolled in HIV care, and retained in HIV care by adding NCD screening and care.

项目概要/摘要 由于以艾滋病毒为中心的服务的耻辱，艾滋病毒检测在社区环境中经常被回避。 研究强烈表明，整合包括艾滋病毒、糖尿病和高血压在内的一揽子筛查 承诺大幅增加艾滋病毒检测的采用率，同时提供急需的服务 对糖尿病和高血压等非传染性疾病 (NCD) 进行社区筛查， 在我们的试点研究中，我们发现艾滋病毒检测几乎在撒哈拉以南非洲地区处于流行水平。 此外，一旦艾滋病毒感染者接受糖尿病和高血压筛查，这一数字就会翻倍。 已发现，由于以艾滋病毒为中心的护理计划的耻辱，许多人不愿意接受护理，并且随着时间的推移 客户流失是一个严重的问题，损害了这些项目的临床和公共卫生效益。 我们的初步研究强烈表明，非传染性疾病护理与艾滋病毒护理的整合将会增加 通过消除所有参与者对诊所的污名化，并提供切实可行的服务，提高艾滋病毒护理的入学率和保留率 为估计 79% 的同时患有非传染性疾病的 HIV 感染者（尤其是等待治疗的患者）提供临床治疗 成为有资格接受 ART 的人，他们也是流失率最高的人。我们将评估： (a) 客户。 基萨拉韦区 6 个艾滋病毒护理和治疗中心 (CTC) 的特点和使用模式， 坦桑尼亚；(b) 艾滋病毒检测趋势；(c) 艾滋病毒干预历史；(d) 人口普查数据； 绘制每个 CTC 服务区域的地图； (f) 咨询社区领袖和医务人员，以及 (g) 接下来，将两个 CTC 之一随机作为增强干预位点。 在这两个 CTC 中，我们将进行社区动员，提醒社区可用的服务。 干预 CTC 我们还将提供糖尿病和高血压的筛查 健康中心（始终）。 毗邻 CTC）将协助治疗感染艾滋病毒的阳性患者。 两个地点的 CTC，每个 CTC 的前 89 名患者将被纳入队列并随访 24- 个月（2 个诊所的 NCD 强化干预队列中的 NCD 患者总数为 178 人）。 阳性者将把非传染性疾病护理与艾滋病毒护理结合起来。我们将评估非传染性疾病筛查的影响。 我们将在大约 18 个月内确定是否将非传染性疾病护理纳入社区层面。 艾滋病毒护理改善了艾滋病毒护理的联系和入学率。我们将确定新近艾滋病毒护理人员是否保留艾滋病毒护理。 通过增加非传染性疾病护理，登记的客户将在 24 个月内得到增强，然后我们将支付所有干预费用。 确定每个增加的接受艾滋病毒检测、参加艾滋病毒护理的客户的增量成本，以及 通过增加非传染性疾病筛查和护理，保留艾滋病毒护理。