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：撒哈拉以南非洲地区艾滋病毒流行的特点是人口患病率高、对艾滋病毒血清状态了解程度低以及大多数艾滋病毒传播发生在稳定的异性伴侣中。没有任何单一的艾滋病毒预防策略能够控制非洲艾滋病毒的流行；因此，需要多层次、多组成部分的预防。我们建议制定一个协调的、多组成部分的艾滋病毒预防一揽子计划，其中包括基于证据的生物医学和行为干预措施，这些干预措施将单独定制并有针对性，以最大限度地扩大覆盖范围和对非洲人口艾滋病毒发病率的影响。该一揽子计划将通过基于社区的家庭 VCT (HBCT) 平台提供，以提高人口层面的覆盖率和血清状况知识，同时在社区层面提供关键的预防信息。 HBCT 已被证明在东非是可行的、可接受的和具有成本效益的，并提供了一种独特的合适机制来识别不知道自己感染艾滋病毒的人、艾滋病毒不一致的夫妇和高危艾滋病毒未感染者——艾滋病毒预防的重点人群。我们假设，利用 HBCT 平台，向高覆盖率的关键亚人群提供个性化的“艾滋病毒预防处方”是可行且可接受的，结合适当的生物医学和行为干预措施，可能协同减少艾滋病毒在人群中的传播。普遍的非洲异性恋流行病。我们的具体目标是： 1. 进行流行病学分析、系统评价和数学建模，以确定撒哈拉以南非洲人口归因比例最高的异性艾滋病毒传播的可改变决定因素，评估针对这些决定因素的有针对性的预防策略的影响，并根据这些分析选择预防方案的组成部分。 2. 试点数据收集，以识别最高风险个体（HIV 不一致的夫妇、HIV 感染者和具有高危行为的 HIV 阴性者），并将行为和生物医学预防干预措施纳入以人群为基础的 HBCT 计划。 3. 在 HBCT 背景下，为东非和南部非洲设计一项全面、有针对性、生物医学和行为艾滋病毒预防方案的社区随机有效性试验。我们的多学科团队包括流行病学家、数学建模师、生物统计学家和研究人员，他们在非洲进行多中心生物医学和行为干预试验方面拥有丰富的专业知识。我们建议将 HBCT 作为一个平台，提供社区范围内的艾滋病毒风险行为评估，并向高危人群提供个性化、多成分的生物医学（例如男性包皮环切术、ART）和行为艾滋病毒预防方案。这种有针对性的“预防处方”将成为该应用产品的基础：针对撒哈拉以南非洲普遍异性恋流行病的多成分艾滋病毒预防方案的未来社区随机试验的设计和方案。基于非洲普遍异性恋流行病中艾滋病毒传播决定因素的流行病学分析和数学模型以及潜在的干预措施，我们将设计一个基于证据的艾滋病毒预防方案，并对该预防方案进行社区随机试验，该试验将在家庭平台上实施针对高危人群开展艾滋病自愿咨询和检测，实现高覆盖率。