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.

项目概要 需要新的策略让撒哈拉以南非洲 (SSA) 的男性参与艾滋病毒检测、治疗和治疗 预防服务，推动疫情消除。艾滋病毒预防工作的参与度不够理想 男性增加了感染艾滋病毒的风险，并且是女性新感染艾滋病毒的重要驱动因素。艾滋病毒自我 测试 (HIVST) 通过利用 预防艾滋病毒的男性同伴网络在 SSA 中是可行、可接受和有效的。 该项目的目标是使用实施科学方法来确定 HIVST 的影响 通过男性社交网络分发 PrEP，并提供基于电话的支持和改善的风险认知 津巴布韦东部男性的接受率。该项目将利用与 20- 在特征明确的人群中开展艾滋病毒监测和行为研究的年度计划 由津巴布韦马尼卡兰公共卫生研究中心提供。鉴于该项目特别合适 最近将 PrEP 作为津巴布韦国家艾滋病应对措施的关键组成部分， 随后在所有当地诊所推广 PrEP。 该研究将采用 44 个聚类的聚类随机设计（22 个干预组：22 个对照），包括 每个集群中平均有 81 名男性（总 N = 3591）跟踪 6 个月（提供 >80% 的能力来检测差异） 男性中 PrEP 启动率分别为 2% 和 8.5%）。在干预集群中，我们将确定初始经销商 将收到供个人使用的 HIVST 套件和分发给当地同行的 HIVST 套件。这些同龄人可以 随后成为分销商，从而允许干预通过同行网络传播。一个免费电话 帮助热线将提供测试前和测试后支持，基于短信的风险评估将加快 PrEP 的启动 在诊所。我们将对干预措施进行绩效（过程）评估。评估实施情况 保真度、试验有效性的因果机制，包括同行网络的特征如何影响 结果。我们将利用研究结果来量化人口水平的影响和成本效益 男性对等 HIVST 分发策略对 HIV 高流行环境中 PrEP 的吸收 完全校准的基于个人的数学模型。这项研究的预期长期影响是 开发一个通用的、多成分的、基于男性同伴的 HIVST 和 PrEP 接受模型 艾滋病毒发病率高的地方。