Harnessing male peer networks to enhance engagement with HIV prevention: A large-scale cluster randomized trial to increase HIV self-testing and PrEP uptake among men in Eastern Zimbabwe

利用男性同伴网络加强艾滋病毒预防的参与：一项旨在提高津巴布韦东部男性艾滋病毒自我检测和 PrEP 接受率的大规模整群随机试验

• 批准号: 10700233
• 负责人: Constance Nyamukapa
• 金额: $ 50万
• 依托单位: STELLENBOSCH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-03 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700233
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Affect; Africa South of the Sahara; African; Automobile Driving; Awareness; Behavioral Research; Calibration; Caring; Characteristics; Clinic; Cluster randomized trial; Communities; Data; Development; Diagnostic Reagent Kits; Epidemic; Evaluation; Face; Female Adolescents; Gender; General Population; Goals; HIV; HIV Infections; HIV Seronegativity; Health; High Prevalence; Human immunodeficiency virus test; Improve Access; Incidence; Individual; Infrastructure; Intervention; Laboratories; Logic; Mathematics; Measures; Methods; Modeling; Network-based; Outcome; Paper; Penetration; Performance; Population; Prevention; Principal Investigator; Process; Research; Risk; Risk Assessment; Rural; Seminal; Social Network; South Africa; Structure; Subgroup; Telephone; Testing; Woman; Work; Zimbabwe; behavior test; care systems; cluster randomized design; cohort; cost effectiveness; eHealth; effectiveness trial; health care availability; implementation evaluation; implementation fidelity; implementation science; improved; innovation; male; mathematical model; meetings; men; novel strategies; peer; peer networks; pre-exposure prophylaxis; prevention service; primary outcome; programs; public health research; response; risk perception; scale up; secondary outcome; self testing; study population; testing services; transmission process; treatment services; uptake; young woman

PROJECT SUMMARY Novel strategies are needed to engage men in Sub Saharan Africa (SSA) with HIV testing, treatment and prevention services to drive the epidemic towards elimination. Suboptimal engagement with HIV prevention by men increases their risk of HIV acquisition, and is an important driver of new HIV infections in women. HIV self- testing (HIVST) addresses several key facility-based access barriers and HIVST distribution through leveraging male peer networks for HIV prevention is feasible, acceptable and effective in SSA. The objective of this project is to use an implementation science approach to establish the impact of HIVST distribution through male social networks, with phone-based support and improved risk perception, on PrEP uptake among men in Eastern Zimbabwe. The project will leverage infrastructure and data associated with 20- year programme of HIV surveillance and behavioural research in a well-characterized population cohort hosted by the Manicaland Centre for Public Health Research, Zimbabwe. The project is particularly opportune given the very recent adoption of PrEP as a key component of the Zimbabwean national AIDS response and the subsequent roll-out of PrEP in all local clinics. The study will utilise a cluster randomised design of 44 clusters (22 Intervention:22 control) comprising on average 81 men in each cluster (total N = 3591) followed for 6 months (giving >80% power to detect a difference in PrEP initiation among men of 2% versus 8.5%). In intervention clusters we will identify initial distributors who will receive an HIVST kit for personal use and HIVST kits to distribute to local peers. These peers can subsequently become distributors, allowing the intervention to propagate through peer networks. A toll-free helpline will provide pre- and post-test support and an SMS-based risk assessment will expedite PrEP initiation at the clinic. We will conduct a performance (process) evaluation of the intervention. to assess implementation fidelity, causal mechanisms underlying trial effectiveness including how characteristics of peer networks affect outcomes. We will use the results of the study to quantify the population level impacts and cost-effectiveness of male peer to peer HIVST distribution strategies on the uptake of PrEP in HIV hyper-endemic settings using a fully calibrated individual-based mathematical model. The envisaged long-term impact of this research is the development of a generalizable, multicomponent male peer-based HIVST and PrEP uptake model for settings where HIV incidence is high.

项目摘要 需要采取新的策略来使男性与撒哈拉以南非洲（SSA）进行艾滋病毒测试，治疗和 预防服务以推动流行病去消除。与预防HIV预防的次优 男性增加了艾滋病毒感染的风险，并且是女性新艾滋病毒感染的重要驱动力。艾滋病自我 测试（HIVST）通过利用来解决几个基于设施的访问障碍和HIVST分布 用于预防HIV的男性同伴网络在SSA中是可行的，可接受且有效的。 该项目的目的是使用实施科学方法来建立HIVST的影响 通过男性社交网络分发，并获得基于电话的支持和改善风险感知的准备 津巴布韦东部男性的吸收。该项目将利用基础架构和与20-相关的数据 在托管的人群中，艾滋病毒监测和行为研究的年度计划 津巴布韦的Manicaland公共卫生研究中心。该项目特别合适 PREP最近通过作为津巴布韦国家艾滋病回应的关键组成部分和 随后在所有本地诊所推出PREP。 该研究将利用44个集群的簇随机设计（22干预：22个控制），其中包括 每个集群中的平均81名男性（总n = 3591）紧随 在2％对8.5％的男性中的准备开始。在干预集群中，我们将确定最初的分销商 将收到HIVST套件供个人使用和HIVST套件分发给本地同行。这些同龄人可以 随后成为分销商，使干预措施通过同行网络传播。免费电话 热线求助热线将提供测试前和后的支持，基于SMS的风险评估将加快PREP启动 在诊所。我们将对干预措施进行性能（过程）评估。评估实施 忠诚度，因果关系机制的基础试验有效性，包括同伴网络的特征如何影响 结果。我们将使用研究结果来量化人口水平的影响和成本效益 男性对同行HIVST分布策略，以使用A 完全校准的基于个体的数学模型。这项研究的长期影响是 开发可概括的，多组分的男性基于同伴的HIVST和用于设置的预备摄取模型 艾滋病毒发病率很高。