Integrating U=U into HIV counseling in South Africa (INTUIT-SA)

将 U=U 纳入南非的艾滋病毒咨询 (INTUIT-SA)

• 批准号: 10082738
• 负责人: Jacob Bor
• 金额: $ 23.49万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10082738
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Africa; Altruism; Appointment; Attitude; Behavior; Boston; Cellular Phone; Child; Clinic; Clinical; Clinical Trials; Collaborations; Consensus; Counseling; Country; Couples; Data; Diagnosis; Disclosure; Education; Effectiveness; Epidemic; Europe; Exercise; Exposure to; Focus Groups; Generations; Guidelines; HIV; HIV Infections; HIV therapy; Intervention; Interview; Knowledge; Lead; Mental Health; Monitor; Motivation; Participant; Patients; Personal Satisfaction; Persons; Policies; Prevention; Prevention strategy; Professional counselor; Public Health; Public Sector; Randomized; Records; Research; Risk; Risk-Taking; Rural; Science; Secondary Prevention; Self Efficacy; Series; Services; Shapes; Societies; South Africa; Standardization; Surveys; Tablets; Testing; Text Messaging; Training; United States National Institutes of Health; Universities; Unsafe Sex; Vertical Disease Transmission; Viral; Viral Load result; Virus; Well in self; Work; antiretroviral therapy; arm; base; care seeking; design; efficacy trial; epidemiology study; experience; health economics; improved; infection risk; innovation; literacy; novel strategies; pilot trial; population based; prevent; psychologic; recruit; research study; social stigma; therapy adherence; transmission process; treatment arm; university student; uptake; young adult; AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Africa; Altruism; Appointment; Attitude; Behavior; Boston; Cellular Phone; Child; Clinic; Clinical; Clinical Trials; Collaborations; Consensus; Counseling; Country; Couples; Data; Diagnosis; Disclosure; Education; Effectiveness; Epidemic; Europe; Exercise; Exposure to; Focus Groups; Generations; Guidelines; HIV; HIV Infections; HIV therapy; Intervention; Interview; Knowledge; Lead; Mental Health; Monitor; Motivation; Participant; Patients; Personal Satisfaction; Persons; Policies; Prevention; Prevention strategy; Professional counselor; Public Health; Public Sector; Randomized; Records; Research; Risk; Risk-Taking; Rural; Science; Secondary Prevention; Self Efficacy; Series; Services; Shapes; Societies; South Africa; Standardization; Surveys; Tablets; Testing; Text Messaging; Training; United States National Institutes of Health; Universities; Unsafe Sex; Vertical Disease Transmission; Viral; Viral Load result; Virus; Well in self; Work; antiretroviral therapy; arm; base; care seeking; design; efficacy trial; epidemiology study; experience; health economics; improved; infection risk; innovation; literacy; novel strategies; pilot trial; population based; prevent; psychologic; recruit; research study; social stigma; therapy adherence; transmission process; treatment arm; university student; uptake; young adult

Project Summary The near-elimination of HIV transmission with antiretroviral therapy (ART) has provided the world with a clear path to end the HIV epidemic through the mass provision of ART at diagnosis, i.e. test-and-treat. Despite the very large prevention benefits of ART, we found very limited knowledge of treatment-as-prevention (TasP) in two population-based surveys we recently conducted in South Africa (Bor K01). Indeed, current public health messaging and clinical HIV counseling in South Africa do not emphasize the prevention benefits of ART. In 2016, U=U Campaign was launched to disseminate the scientific evidence that people with HIV cannot transmit the virus if their viral load is undetectable. U=U has been endorsed by NIH and by organizations in nearly 100 countries. Anecdotal evidence suggests providing information on U=U may reduce stigma and improve wellbeing of PLWH, and may lead to increased ART uptake and adherence by appealing to the desire of PLWH to avoid transmission to others. Although the science on U=U is clear, there is currently a critical evidence gap on (a) how best to integrate information on U=U into HIV counseling services, and (b) what impact U=U messaging has on wellbeing of PLWH and on treatment-seeking behaviors. We propose a formative research study (R34) to develop an app-based educational video intervention that will provide information on U=U that is locally-appropriate and can be integrated into routine HIV counselling. We will pilot the intervention in a clinical trial of patients receiving HIV post-test and adherence counseling services, in order to determine feasibility and acceptability, impact on U=U knowledge and attitudes, impact on stigma and psychological wellbeing, and preliminary evidence for ART uptake, adherence, and viral monitoring and suppression. The study builds on a longstanding collaboration between Boston University and the Health Economics and Epidemiology Research Office (HE2RO) at the University of Witwatersrand in South Africa. This study is highly innovative because we take a novel approach – disseminating information on the prevention benefits of ART – to improve wellbeing of PLWH and motivate early uptake of ART in South Africa. Study results will inform an R01 proposal to evaluate the impact of this intervention on viral suppression in a cluster-randomized efficacy trial. The research will have significant public health impact as the findings have potential to shape HIV counseling guidelines and practice in the country with the world’s largest HIV epidemic. We hypothesize that selling treatment-as-prevention on its merits could substantially improve wellbeing of PLWH and increase demand for ART, enabling countries to maximize the impact of test-and-treat.

项目摘要 抗逆转录病毒疗法（ART）的艾滋病毒传播近乎灭绝已为世界提供了清晰的 通过诊断时的批量提供ART，即测试和治疗，结束HIV流行的途径。尽管有 我们发现，对艺术的预防益处非常大，我们发现对治疗方法的了解非常有限（TASP） 在我们最近在南非进行的两项基于人群的调查中（BOR K01）。确实，当前的公共卫生 南非的消息传递和临床艾滋病毒咨询并不强调艺术的预防益处。 2016年，发起了U = U运动，以传播艾滋病毒患者的科学证据 如果无法检测到病毒，则无法传递病毒。 u = u已得到NIH的认可和 近100个国家的组织。轶事证据表明提供有关U = U的信息可能会减少 污名和改善PLWH的福祉，并可能通过出现来增加艺术的吸收和依从性 为了避免向他人传播的愿望。尽管u = u的科学很清楚，但目前有 关于（a）如何最好地将有关U = U的信息纳入艾滋病毒咨询服务的关键证据差距， （b）u = u消息传递对PLWH和寻求治疗行为的影响有什么影响。 我们提出了一项形成性研究（R34），以开发基于应用程序的教育视频干预措施 将提供有关u = u的信息，该信息可将当地适合，可以集成到常规的艾滋病毒咨询中。 我们将对接受HIV后测试后和依从性咨询的患者进行临床试验进行干预 为了确定可行性和可接受性，对U = U = U知识和与会者的影响 污名和心理健康，以及艺术吸收，依从性和病毒监测的初步证据 和抑制。这项研究建立在波士顿大学与健康之间的长期合作基础上 南非维特沃特斯兰大学的经济学和流行病学研究办公室（HE2RO）。 这项研究具有很高的创新性，因为我们采用了一种新颖的方法 - 传播有关 预防艺术的好处 - 改善PLWH的健康和动机在南非的艺术早期吸收。 研究结果将为R01提案提供信息，以评估这种干预对病毒抑制的影响 集群随机效率试验。这项研究将对研究结果产生重大的公共卫生影响 以世界上最大的艾滋病毒流行病来塑造该国艾滋病毒咨询指南和实践的潜力。 我们假设在其优点上出售预防治疗可能会大大改善福祉 PLWH和对艺术的需求增加，使国家能够最大程度地提高测试和治疗的影响。