Innovative strategies to increase ART Initiation and viral suppression among HIV+ men in Malawi

提高马拉维艾滋病毒男性的抗逆转录病毒治疗启动和病毒抑制的创新策略

• 批准号: 10667601
• 负责人: Kathryn L Dovel
• 金额: $ 13.9万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10667601
• 关键词: Address; Adopted; Adverse event; Africa South of the Sahara; Area; Baseline Surveys; Biometry; Caring; Characteristics; Client; Clinical Trials; Coping Skills; Counseling; Country; Data; Development; Development Plans; Diagnostic Reagent Kits; Disclosure; Effectiveness; Effectiveness of Interventions; Enrollment; Ensure; Epidemic; Ethics; Female; Focus Groups; Fright; Goals; HIV; HIV Seropositivity; Health Personnel; Health Services Accessibility; Health care facility; Home; Home visitation; Human immunodeficiency virus test; Individual; Intervention; Interview; Knowledge; Location; Maintenance; Malawi; Mentored Research Scientist Development Award; Mentors; Mentorship; Modeling; Newly Diagnosed; Outcome; Population; Privacy; Public Health; Randomized, Controlled Trials; Research; Research Activity; Research Personnel; Resource-limited setting; Respondent; Risk; Sample Size; Scientist; Service delivery model; Services; Sexual Partners; Social Sciences; Statistical Methods; Testing; Therapeutic Intervention; Time; Training; Viral; Woman; antiretroviral therapy; arm; barrier to care; career development; clinical practice; cost; epidemic response; evidence base; experience; home test; improved; indexing; informant; innovation; intervention delivery; intervention refinement; male; men; multidisciplinary; novel strategies; pilot trial; primary outcome; randomized trial; retention rate; secondary outcome; self testing; seroconversion; service delivery; skills; social; social observations; social stigma; standard care; standard of care; success; testing services; theories; treatment services

Project Summary Men continue to be missed by HIV testing and treatment services. Index partner testing is a critical strategy for reaching men. Index HIV self-testing (HIVST), whereby ART clients take HIVST kits home to their sexual partners for testing, is a new strategy that dramatically increases index testing among men, and is being taken to scale across Malawi. However, only 25% of men identified as HIV-positive through Index HIVST initiate ART after 6- months. Innovative strategies to increase ART initiation and retention among men are urgently needed. The overarching goal of the proposed K01 is to develop and pilot a home-based ART intervention (ART initiation + 3-months ART care) to increase ART initiation (primary outcome) and 6-month viral suppression (secondary outcome) among men who test HIV-positive through Index HIVST in Malawi. Candidate: I am a social scientist with a background in HIV research in sub-Saharan Africa. My long-term goal is to transition from observational social science to clinical trials research in innovative HIV service delivery models among hard-to-reach populations, such as men. I am applying for a five-year K01 award to obtain training, mentorship, and research experience. Mentoring: I have an exceptional multi-disciplinary mentoring team with extensive experience in HIV care and management and clinical trials in the region. The team has complementary expertise in social science and clinical trials in HIV service delivery models (Dr. Thomas Coates – Primary Mentor), best practices in HIV care and management and differentiated models of care in Malawi (Drs. Judith Currier and Risa Hoffman), scalability and sustainability of interventions (Dr. Sundeep Gupta – Malawi-based), and advanced biostatistics (Dr. Ron Brookmyer). Career Development: To achieve my long-term goals, we have developed a detail plan to build skills in four additional areas: (1) best clinical practices for ART care and maintenance; (2) clinical trials in novel approaches to HIV service delivery; (3) advanced statistical methods; and (4) ethics in clinical trials research in low-resource settings. Research Activities: The specific aims accompanying the career development plan are to: (1) Develop a home-based ART intervention for male partners tested through Index HIVST, using in-depth interviews with male Index HIVST users (n=15-20) and their partners (n=15-20), and focus group discussions with key informants (n=18-30). (2) Determine the potential effectiveness of home-based ART versus standard facility-based ART (on ART initiation (primary outcome) and 6-month viral suppression (secondary outcome) among male Index HIVST users in a pilot trial with 200 HIV-positive men. Expected Outcomes: Results from this study will inform definitive trial to test home-based ART services for men identified as HIV-positive through index HIVST strategies. The project will also give me the additional skillsets needed to become an independent investigator in clinical trials.

项目概要 男性仍然被艾滋病毒检测和治疗服务所忽视，指数伴侣检测是一项重要策略。 艾滋病毒自我检测 (HIVST) 索引，即 ART 客户将 HIVST 试剂盒带回家给他们的性伴侣。 测试是一种新策略，可显着增加男性的指数测试，并且正在扩大规模 然而，只有 25% 的男性通过 HIVST 指数确定为 HIV 阳性，并在 6 年后开始接受 ART。 迫切需要创新策略来提高男性的 ART 启动率和保留率。 拟议的 K01 的总体目标是开发和试点基于家庭的 ART 干预措施（ART 启动 + 3 个月的 ART 护理）以增加 ART 的启动（主要结果）和 6 个月的病毒抑制（次要结果） 候选人：我是一名社会科学家。 具有撒哈拉以南非洲艾滋病毒研究背景 我的长期目标是从观察性转变。 从社会科学到临床试验研究，在难以接触到的人群中创新艾滋病毒服务提供模式 我正在申请为期五年的 K01 奖项以获得培训、指导和研究。 指导经验：我拥有一支出色的多学科指导团队，在以下方面拥有丰富的经验。 该团队在该地区的艾滋病毒护理和管理以及临床试验方面拥有互补的专业知识。 HIV 服务提供模式的科学和临床试验（Thomas Coates 博士 - 主要导师）、最佳实践 马拉维的艾滋病毒护理和管理以及差异化护理模式（Judith Currier 博士和 Risa Hoffman 博士）， 干预措施的可扩展性和可持续性（Sundeep Gupta 博士 – 马拉维）以及先进的生物统计学 （罗恩·布鲁克梅尔博士）：为了实现我的长期目标，我们制定了详细的计划。 培养另外四个领域的技能：(1) ART 护理和维护的最佳临床实践；(2) 临床试验； 提供艾滋病毒服务的新方法；(3) 先进的统计方法；(4) 临床试验的伦理学； 在资源匮乏的环境中进行研究 研究活动：具体目标伴随着职业生涯。 发展计划是： (1) 为通过 Index 测试的男性伴侣制定家庭 ART 干预措施 HIVST，对男性 HIVST 指数使用者 (n=15-20) 及其伴侣 (n=15-20) 进行深入访谈，并关注重点 与主要知情人进行小组讨论 (n=18-30) (2) 确定家庭 ART 的潜在有效性。 与基于标准设施的 ART 相比（关于 ART 启动（主要结果）和 6 个月病毒抑制） （次要结果）是针对 200 名 HIV 阳性男性的试点试验中的男性 HIVST 使用者。 结果：这项研究的结果将为最终试验提供信息，以测试针对已确定男性的家庭 ART 服务 通过索引 HIVST 策略作为艾滋病毒阳性者，该项目还将为我提供所需的额外技能。 成为临床试验的独立研究者。

项目成果

Microfinance and Peer Health Leadership Intervention Implementation for Men in Dar es Salaam, Tanzania: A Qualitative Assessment of Perceived Economic and Health Outcomes.

坦桑尼亚达累斯萨拉姆男性小额信贷和同伴健康领导干预实施：对预期经济和健康成果的定性评估。

• 发表时间: 2020
• 作者: Mhando, Frank;Dovel, Kathryn;Jennings Mayo;Rwehumbiza, Deusdedit;Thompson, Noah;Nwaozuru, Ucheoma;Rehani, Abubakar;Iwelunmor, Juliet;Nelson, LaRon E;Conserve, Donaldson Fadael
• 通讯作者: Conserve, Donaldson Fadael

A Qualitative Assessment of Provider and Client Experiences With 3- and 6-Month Dispensing Intervals of Antiretroviral Therapy in Malawi.

对马拉维 3 个月和 6 个月的抗逆转录病毒治疗配药间隔的提供者和客户体验进行定性评估。

• 发表时间: 2020
• 作者: Hubbard, Julie;Phiri, Khumbo;Moucheraud, Corrina;McBride, Kaitlyn;Bardon, Ashley;Balakasi, Kelvin;Lungu, Eric;Dovel, Kathryn;Kakwesa, Gift;Hoffman, Risa M
• 通讯作者: Hoffman, Risa M