Multi-component, Targeted HIV Prevention for sub-Saharan Africa: PreventionRx

撒哈拉以南非洲地区多组成部分、有针对性的艾滋病毒预防：PreventionRx

• 批准号: 8130323
• 负责人: CONNIE L CELUM
• 金额: $ 50万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-17 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8130323
• 关键词: AIDS prevention; Accounting; Adult; Africa; Africa South of the Sahara; African; Area; Behavior Therapy; Behavior assessment; Behavioral; Clinical Trials; Communities; Contracts; Counseling; Coupled; Couples; Data; Data Collection; Epidemic; Epidemiologic Studies; Epidemiologist; Epidemiology; Evaluation; Foundations; Future; General Population; HIV; HIV Infections; Heterosexuals; Home environment; Household; Human immunodeficiency virus test; Incidence; Individual; Intervention; Intervention Trial; Knowledge; Link; Low Prevalence; Magic; Male Circumcision; Measurement; Methodology; Persons; Population; Population Attributable Risks; Prevalence; Prevention; Prevention program; Prevention strategy; Preventive Intervention; Protocols documentation; Randomized; Research Personnel; Risk; Risk Factors; Risk Reduction; Sexually Transmitted Diseases; Southern Africa; Target Populations; Testing; Uganda; Virus; abstracting; base; condoms; cost; design; effectiveness trial; evidence base; high risk; high risk behavior; mathematical model; pandemic disease; population based; prevention service; programs; randomized trial; sex; success; systematic review; transmission process

DESCRIPTION (provided by applicant): Abstract: The generalized HIV epidemics in sub-Saharan Africa are characterized by high population prevalence, low knowledge of HIV serostatus, and the majority of HIV transmissions occurring within stable heterosexual partnerships. No single HIV prevention strategy will control the African HIV epidemic; thus, multi-layered and multi-component prevention will be needed. We propose to develop a coordinated, multi-component HIV prevention package of evidence-based biomedical and behavioral interventions that will be individually-tailored and targeted to maximize coverage and impact on HIV incidence in an African population. The package will be delivered through a community-based platform of household-based VCT (HBCT) to enhance population-level coverage and knowledge of serostatus, coupled to community-level delivery of key prevention messages. HBCT has been demonstrated to be feasible, acceptable and cost-effective in East Africa and provides a uniquely suitable mechanism to identify persons unaware of their HIV infection, HIV discordant couples, and high-risk HIV uninfected persons - high priority populations for targeting HIV prevention. We hypothesize that, using a HBCT platform, it is feasible and acceptable to deliver an individualized "HIV prevention prescription" to critical subpopulations with high levels of coverage, combining appropriate biomedical and behavioral interventions that are likely to synergistically reduce population-level HIV transmission in the generalized African heterosexual epidemic. Our Specific Aims are to: 1. Conduct epidemiologic analyses, systematic reviews, and mathematical modeling to identify modifiable determinants of heterosexual HIV transmission with the highest population-attributable fraction in sub-Saharan Africa, estimate the impact of targeted prevention strategies directed at these determinants, and select components of a prevention package based on these analyses. 2. Pilot data collection for identification of highest-risk individuals (HIV discordant couples, HIV-infected persons, and HIV-negative persons with high-risk behaviors) with integration and targeting of behavioral and biomedical prevention interventions into population-based HBCT programs. 3. Design a community-randomized effectiveness trial of a comprehensive, targeted, biomedical and behavioral HIV prevention package for East and southern Africa in the context of HBCT. Our multi-disciplinary team includes epidemiologists, mathematical modelers, biostatisticians, and investigators with extensive expertise in conducting multi-center biomedical and behavioral intervention trials in Africa. We propose HBCT as a platform to deliver community-wide behavioral assessment of HIV risk and to provide individualized, multi-component biomedical (e.g., male circumcision, ART) and behavioral HIV prevention packages to at-risk individuals. This targeted "prevention prescription" will be the foundation for the product of this application: a design and protocol for a future community-randomized trial of a multi-component HIV prevention package for the generalized heterosexual epidemics in sub-Saharan Africa. Based on epidemiologic analyses and mathematical modeling of HIV transmission determinants in generalized heterosexual epidemics in Africa and potential interventions, we will design an evidence-based HIV prevention package and a community-randomized trial of this prevention package which will be implemented on a platform of home-based voluntary HIV counseling and testing to target high-risk persons and achieve high levels of coverage.

描述（由申请人提供）： 摘要：撒哈拉以南非洲的广义艾滋病毒流行病的特征是人口较高，对艾滋病毒血清的知识较低以及大多数HIV传播发生在稳定的异性恋伙伴关系中。没有单一的艾滋病毒预防策略将控制非洲的艾滋病毒流行；因此，需要多层和多组分预防。我们建议开发一种协调的，多组分的HIV预防措施，包括基于证据的生物医学和行为干预措施，这些措施将被分别限制和针对性，以最大程度地提高非洲人群的覆盖范围和对HIV发病率的影响。该软件包将通过基于社区的家庭VCT（HBCT）的平台提供，以增强人口级别的覆盖范围和对血清的知识，并与社区级别的关键预防信息交付。在东非，HBCT已被证明是可行的，可接受的和具有成本效益的，并提供了一种独特的机制，可以识别出不知道其HIV感染的人，HIV不一致的夫妻和高风险的HIV未感染的人 - 高优先级的优先人群，可用于靶向HIV预防HIV。我们假设，使用HBCT平台，将个性化的“ HIV预防处方”提供给具有较高覆盖范围的关键亚人群，结合适当的生物医学和行为干预措施，可以协同降低人口级别的HIV传播，这是可行的，并且可以接受。我们的具体目的是：1。进行流行病学分析，系统评价和数学建模，以确定异性恋HIV传播的可修改决定因素，在撒哈拉以南非洲地区的人口最高分数，估计针对这些确定性的预防策略的影响，这些策略是针对这些确定性的预防策略的影响，这些策略是根据这些确定的组成部分和这些分析的套件来估算的。 2。用于鉴定最高风险个体的试点数据（HIV不一致的夫妻，感染了HIV的人和具有高风险行为的HIV阴性人），并将行为和生物医学预防干预措施整合到基于人群的HBCT计划中。 3.在HBCT的背景下，针对东非和南部非洲的全面，有针对性，生物医学和行为艾滋病毒预防计划设计了社区随机的有效性试验。我们的多学科团队包括流行病学家，数学建模者，生物统计学家以及在非洲进行多中心生物医学和行为干预试验方面具有广泛专业知识的研究人员。我们建议HBCT作为对艾滋病毒风险进行社区范围的行为评估的平台，并为处于危险中的个体提供个性化的，多组分的生物医学（例如，男性包皮环切术，艺术）和行为艾滋病毒预防套餐。该针对性的“预防处方”将成为此应用程序产品的基础：用于未来社区随机试验的设计和协议，该试验是针对撒哈拉以南非洲广泛性异性流行病的多组分艾滋病毒预防套件。基于非洲广义异性流行病的艾滋病毒传播决定因素的流行病学分析和数学模型，我们将设计一个基于证据的艾滋病毒预防套件，以及该预防套件的社区伴随试验，该试验将在基于自愿的艾滋病毒咨询和测试平台上实施，以覆盖高级高级人士，以覆盖高度的高级人士。