An HIV Prevention Program for Mochudi, Botswana

博茨瓦纳莫丘迪艾滋病毒预防项目

• 批准号: 8136647
• 负责人: MYRON E ESSEX
• 金额: $ 79.69万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-29 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8136647
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Acute; Adherence; Adult; Affect; Africa; Age; Anniversary; Anti-Retroviral Agents; Area; Behavior Therapy; Behavioral; Blood; Botswana; Chemoprophylaxis; Chronic; Collection; Communicable Diseases; Communities; Contact Tracing; Counseling; Demography; Detection; Development; Disease; Drug Combinations; Drug resistance; Education; Effectiveness; Elderly; Epidemic; Epidemiologist; Epidemiology; Evaluation; Genome; Genotype; Goals; Government; Grant; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health Policy; Herpes Simplex Infections; High Prevalence; Highly Active Antiretroviral Therapy; Human immunodeficiency virus test; Incidence; Indium; Individual; Infant; Infection; Infection prevention; Intervention; Joints; Learning; Location; Male Circumcision; Measures; Modeling; Mothers; Partner Notification; Patients; Pattern; Perinatal; Persons; Pharmaceutical Preparations; Population; Pregnant Women; Prevalence; Prevention; Prevention program; Preventive; Preventive Intervention; Prophylactic treatment; Public Health; Qualifying; Recommendation; Research; Risk Factors; Risk Reduction; Schedule; Scientist; Screening procedure; Sequence Analysis; Source; Southern Africa; Specific qualifier value; Spottings; Staging; Surveys; Testing; Time; Update; Vaccines; Viral; Viral Genome; Viral Load result; Virus; base; condoms; cost effectiveness; indexing; interest; intervention program; male; mathematical model; microbicide; prevent; programs; reproductive; scale up; social; tool; transmission process; uptake; viral RNA

DESCRIPTION (provided by applicant): An HIV Prevention Program for Mochudi, Botswana Summary According to UNAIDS, Botswana has the second-highest prevalence of HIV in the world. Within Africa, Botswana has achieved the highest rates of voluntary HIV testing and of provision of free HAART and perinatal HIV transmission prevention interventions. Nevertheless, HIV prevalence/incidence have not changed significantly despite ongoing prevention and treatment efforts, and considerable local interest exists in implementation of more effective prevention interventions. We propose a comprehensive package of behavioral and biomedical interventions to 15-49-year-olds in Mochudi, a village in the south of Botswana, including (1) routine, opt-out HIV testing; (2) education to encourage behavior modification, including condom use; (3) male circumcision; and (4) three-drug HAART for HIV-infected persons with acute infections and/or high viral loads (VL). We will determine HIV prevalence and incidence using repeated screening of the entire population in Mochudi before and after implementation of interventions. Uptake of HIV testing, condom use, and other behavioral recommendations will be assessed from repeated surveys of the entire village. Uptake of the other interventions, and the sources of incident infections investigated using PCR and contact tracing, would be evaluated in the northeast section of Mochudi (population, 14,000). Viral genotyping will be performed to identify potential viral networks or clusters by sequence analysis of infected individuals. Mathematical models will be developed and parameterized to reflect the epidemic in Mochudi and updated by information from surveillance activities. These models will be used to identify potential synergies among preventive measures and to estimate what combined levels of coverage/uptake and effectiveness must be achieved to hold the effective reproductive number of the virus in the community below one. The Specific Aims are (1) to characterize the HIV epidemic in Mochudi by estimating incidence and prevalence of HIV and of behavioral risk factors at 3 time points over a 21/2-year period; (2) to determine uptakes of voluntary counseling and testing, condom use, acceptability of partner notification with contact tracing, and male circumcision; (3) to identify transmission associations with genome signature tracing to evaluate associations between transmissions and high VL; (4) to estimate the rate of acceptance of HAART offered upon detection to HIV-infected individuals with acute infection and/or VL e 100,000 who do not otherwise qualify for treatment based on national guidelines (AIDS-defining illness or CD4 < 250), and to assess adherence to drug schedules and rates of baseline and new drug resistance; and (5) to develop model-based projections and assessments of the potential for epidemic control, and to use these models to evaluate the cost effectiveness of combinations of preventive interventions. An HIV Prevention Program for Mochudi, Botswana Relevance The goal of the application is to demonstrate the feasibility and acceptability of a comprehensive program of interventions to reduce HIV incidence in Mochudi, a village of 39,000 people in southern Botswana with an HIV prevalence of 25% in adults. This combination of interventions will include education for behavior modification, circumcision of adult males, and the use of antiretroviral drugs to decrease transmission at the community level. The ultimate goal is to evaluate prevention interventions that could be scaled up as public health policy in Botswana and southern Africa.

描述（由申请人提供）： 博茨瓦纳（Botswana）摘要是针对Mochudi的艾滋病毒预防计划，博茨瓦纳（Botswana）是世界上艾滋病毒（HIV）第二高的艾滋病毒。在非洲，博茨瓦纳的自愿艾滋病毒测试率最高，并提供了自由HAART和围产期HIV传播预防干预措施。尽管如此，尽管进行了预防和治疗工作，但艾滋病毒的患病率/发病率并未发生重大变化，并且在实施更有效的预防干预措施时仍存在相当大的当地利益。我们为15-49岁的莫丘迪（Mochudi）提出了一套全面的行为和生物医学干预措施，即博茨瓦纳（Botswana）南部的一个村庄，包括（1）常规，退出HIV测试； （2）鼓励行为修改的教育，包括使用避孕套； （3）男性包皮环切术； （4）患有急性感染和/或高病毒载荷（VL）的HIV感染者的三毒HAART。我们将使用在实施干预措施之前和之后对Mochudi的整个人群重复筛选艾滋病毒的患病率和发病率。将从整个村庄的重复调查中评估艾滋病毒测试，避孕套和其他行为建议的吸收。将在Mochudi东北部（人口，14,000）评估其他干预措施的吸收，以及使用PCR和接触跟踪研究的事件感染来源。将通过对感染个体的序列分析来鉴定潜在的病毒网络或簇来识别潜在的病毒网络或集群。数学模型将被开发和参数化，以反映Mochudi的流行，并通过监视活动中的信息进行了更新。这些模型将用于确定预防措施之间的潜在协同作用，并估计必须实现哪些覆盖范围/摄取和有效性的总和，以在一个下方的社区中保持有效的繁殖型病毒数量。具体目的是（1）通过在21/2年期间在3个时间点估算3个时间点的艾滋病毒的发生率和患病率和行为风险因素的发生率和行为风险因素的发生率； （2）确定摄取自愿咨询和测试，使用安全套，与接触跟踪的伴侣通知的可接受性以及男性包皮环切术； （3）确定与基因组特征跟踪的传播关联，以评估传输与高VL之间的关联； （4）估计对急性感染的HIV感染者和/或VL E 100,000的检测后接受的HAART接受率，他们原本没有根据国家准则（定义艾滋病疾病或CD4 <250）进行治疗的资格，并评估对基准和新耐药性药物计划和耐药率的依从性； （5）开发基于模型的预测和评估流行病的潜力，并使用这些模型来评估预防干预措施组合的成本效益。博茨瓦纳一项针对摩丘迪的艾滋病毒预防计划，该申请的目的是证明一项全面的干预措施的可行性和可接受性，以减少莫丘迪（Mochudi）的艾滋病毒发病率，莫丘迪（Mochudi）的艾滋病毒发生率是39,000人在波茨瓦纳南部的39,000人村庄，其艾滋病毒患者患者的艾滋病毒患者为25％。干预措施的这种结合将包括进行行为修改，成年男性包皮环切术以及使用抗逆转录病毒药物来减少社区水平传播的教育。最终目标是评估可以在博茨瓦纳和南部非洲作为公共卫生政策扩展的预防干预措施。