Self-Test Strategies and Linkage Incentives to Improve ART and PrEP Uptake in Men

提高男性 ART 和 PrEP 采用率的自测策略和关联激励措施

基本信息

批准号：
10214463
负责人：
Carol Suzanne Camlin
金额：
$ 60.32万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10214463
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Adherence Affect Africa South of the Sahara Behavior Behavior Therapy Biological Assay Caring Clinic Cluster randomized trial Communities Control Groups Country Epidemic Fishes Foundations Gender HIV HIV Seronegativity HIV Seropositivity HIV antiretroviral HIV risk Health Health Services Accessibility Human immunodeficiency virus test Immunoassay Incentives Incidence Intervention Kenya Measures Methods Network-based Outcome Participant Pathway interactions Policies Population Positioning Attribute Prevalence Prevention Price Privacy Public Health Randomized Research Risk Services Social Network Tenofovir Testing Training Urine Woman Work antiretroviral therapy behavior influence behavioral economics cost financial incentive group intervention high risk improved innovation insight men new technology novel strategies peer influence point of care pre-exposure prophylaxis prevention service promoter recruit referral services scale up screening self testing sex social stigma testing uptake transmission process treatment services uptake voucher

项目摘要

Project Summary Ending the AIDS epidemic in sub-Saharan will require further engagement of men in HIV testing, prevention, and treatment, a challenging task given that nearly 50% of HIV-positive men in many countries are unaware of their HIV status and men have lower uptake of HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP). This study focuses on a highly mobile population of men – fishermen – in Kenya’s Lake Victoria shoreline communities, where HIV incidence rates are extremely high. Two recent innovations – HIV self- testing (HIVST) and social network-based interventions – hold promise for overcoming barriers to HIV testing and linkage to services for both HIV-positive and HIV-negative men. This study seeks to determine if an HIV status-neutral, social network-based approach, along with low-cost incentives, can promote HIV testing, linkage to care and prevention, and better health outcomes in men. It will pursue three aims: Aim 1: Determine whether providing HIV self-tests to network-central men for distribution to other men in their close social networks increases men’s HIV testing uptake. We will conduct social network mapping in study communities in Siaya Country, Kenya to identify distinct close social networks of men. We will then randomize these social networks to intervention and control groups. Network-central, highly- connected men in each network will be recruited as “promoters”, and receive HIVST training. Promoters in networks assigned to the intervention will then receive self-tests for distribution to men in their networks. Promoters in networks assigned to the control will instead distribute vouchers for free self-tests at nearby health clinics. We hypothesize higher HIV testing among men in networks that receive the intervention. Aim 2: Determine whether network-central promoters and small incentives can increase ART and PrEP uptake among men. We will test whether network-central promoters can enhance linkage to ART and PrEP after self-testing, thereby addressing a key limitation of HIVST. Promoters in the Aim 1 intervention group will be asked to distribute information and transport vouchers for ART or PrEP to men in their networks. Our primary hypothesis is that the intervention will result in higher rates of linkage to ART or PrEP (confirmatory testing and ART referral for positives, and PrEP screening for negatives). We also hypothesize higher ART and PrEP uptake within 3 months among men in social networks assigned to the intervention group. Aim 3: Test the impact of interventions on ART or PrEP retention and adherence. We will measure 6- and 12-month VL and tenofovir levels, using a recently-developed low-cost, point-of-care PrEP adherence urine immunoassay. Across all aims, we will use qualitative and mixed methods to identify the pathways of intervention action, and understand how social networks and incentives affect testing and ART and PrEP uptake and retention. This study promises high scientific and public health impact, by testing new approaches to improve the prevention and care cascades in high-risk, mobile men in high priority settings.

项目概要结束撒哈拉以南地区的艾滋病流行需要男性进一步参与艾滋病毒检测、预防、鉴于许多国家近 50% 的艾滋病毒阳性男性不知道这一点，这是一项艰巨的任务他们的艾滋病毒状况和男性对艾滋病毒抗逆转录病毒治疗（ART）和暴露前预防的接受率较低（PrEP）这项研究重点关注肯尼亚维多利亚湖中流动性较高的男性群体——渔民。艾滋病毒发病率极高的海岸线社区最近有两项创新——艾滋病毒自我检测。检测（HIVST）和基于社交网络的干预措施——有望克服艾滋病毒检测的障碍以及与艾滋病毒阳性和艾滋病毒阴性男性的服务的联系本研究旨在确定是否患有艾滋病毒。地位中立、基于社交网络的方法以及低成本激励措施可以促进艾滋病毒检测，它将实现三个目标：目标 1：确定是否向网络中心男性提供艾滋病毒自我检测，并分发给其他男性在他们的密切社交网络中增加男性的艾滋病毒检测率我们将开展社交网络。在肯尼亚西亚亚县的研究社区中绘制地图，以确定男性独特的紧密社交网络。然后，我们将这些社交网络随机分配给以网络为中心的、高度干预的群体。每个网络中的相关人员将被招募为“推广者”，并接受 HIVST 推广者培训。然后，分配给干预措施的网络将收到自我测试，并分发给其网络中的男性。分配给控制组的促销员将改为分发优惠券网络，以便在附近进行免费自测我们在接受干预的网络中的男性中寻求更高的艾滋病毒检测率。目标 2：确定网络中心发起者和小额激励措施是否可以增加 ART 和 PrEP 我们将测试网络中心促进者是否可以增强与 ART 和 PrEP 的联系。自我测试后，从而解决了 Aim 1 干预组中 HIVST 促进者的一个关键限制。我们将被要求向其网络中的男性分发 ART 或 PrEP 的信息和交通券。主要假设是干预措施将导致与 ART 或 PrEP 的关联率更高（证实阳性的测试和 ART 转诊，以及阴性的 PrEP 筛查）我们还获得了更高的 ART 水平。分配到干预组的社交网络中的男性在 3 个月内对 PrEP 的采用情况。目标 3：测试干预措施对 ART 或 PrEP 保留和依从性的影响我们将衡量 6-。以及 12 个月的 VL 和替诺福韦水平，使用最近开发的低成本、即时护理 PrEP 依从性在所有目标中，我们将使用定性和混合方法来确定途径。干预行动，并了解社交网络和激励措施如何影响检测以及 ART 和 PrEP 通过测试新的内容，这项研究有望对科学和公共卫生产生重大影响。改善高优先级环境中高风险、流动男性的预防和护理级联的方法。