Engaging men through HIV self-test and differentiated care models to increase ART initiation and viral suppression in Malawi

通过艾滋病毒自检和差异化护理模式吸引男性参与，以增加马拉维的抗逆转录病毒治疗启动和病毒抑制

• 批准号: 10013734
• 负责人: Thomas J. Coates
• 金额: $ 64.3万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-17 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10013734
• 关键词: Address; Adverse event; Africa South of the Sahara; Baseline Surveys; Caring; Characteristics; Client; Clinical; Cost Analysis; Cost Effectiveness Analysis; Decision Making; Disclosure; Enrollment; Epidemic; Female; Fright; Gender; Goals; HIV; HIV Seropositivity; Health Services Accessibility; Home environment; Human immunodeficiency virus test; Individual; Intention; International; Intervention; Interview; Joints; Knowledge; Location; Malawi; Modeling; Outcome; Perception; Phase; Policies; Population; Privacy; Public Health; Randomized Clinical Trials; Randomized Controlled Trials; Recommendation; Reporting; Safety; Services; Sexual Partners; Testing; Time; Use Effectiveness; Viral; Viral Load result; Woman; Work; arm; base; coping; cost; cost effective; cost effectiveness; cost-effectiveness ratio; design; effectiveness testing; experience; high risk men; improved; incremental cost-effectiveness; indexing; innovation; male; men; motivational enhancement therapy; novel strategies; peer; randomized trial; recruit; scale up; service delivery; social stigma; sociodemographics; standard of care; testing services; transmission process; treatment services; uptake

Project Summary Men continue to be missed by HIV testing and treatment services. Index partner testing is a critical strategy for reaching men. Index HIV self-testing (HIVST), whereby ART clients take HIVST kits home to their sexual partners for testing, is a new strategy that dramatically increases index testing among men, and is being taken to scale across Malawi. However, only 25% of men identified as HIV-positive through Index HIVST initiate ART after 6- months. Innovative strategies to increase ART initiation and retention among men are urgently needed. The overarching goal of the proposed R01 is to test a home-based ART intervention (ART initiation + 3-months ART care) plus motivational interviewing to increase ART initiation and 6-month viral suppression among men who test HIV-positive through Index HIVST in Malawi. The specific aims are: (1) test the effectiveness of home-based versus facility-based ART on ART initiation and 6-month viral suppression among male partners who test through Index HIVST; (2) Identify predictors of ART initiation and 6-month viral suppression; and (3) Determine the cost and cost-effectiveness of home-based ART versus facility-based among male partners using Index HIVST. The trial will provide urgent information on innovative HIV service delivery strategies for hard-to-reach-populations, such as men. Findings are expected to inform national policy and international recommendations around combined differentiated models that reach across the HIV treatment cascade.

项目概要 男性仍然被艾滋病毒检测和治疗服务所忽视。指数合作伙伴测试是一项关键策略 到达男性。索引 HIV 自检 (HIVST)，ART 客户将 HIVST 试剂盒带回家给他们的性伴侣 测试是一种新策略，可显着增加男性的指数测试，并且正在扩大规模 横跨马拉维。然而，只有 25% 的男性通过 HIVST 指数确定为 HIV 阳性，并在 6 年后开始接受 ART 几个月。迫切需要采取创新策略来提高男性的抗逆转录病毒疗法的启动率和保留率。这 拟议 R01 的总体目标是测试家庭 ART 干预（ART 启动 + 3 个月 ART 护理）加上动机访谈，以增加男性中 ART 的启动和 6 个月的病毒抑制 在马拉维，通过 HIVST 指数检测艾滋病毒呈阳性。具体目标是：（1）检验居家办公的有效性 与基于设施的 ART 相比，测试通过的男性伴侣开始 ART 和 6 个月的病毒抑制 HIVST 指数； (2) 确定 ART 启动和 6 个月病毒抑制的预测因素； (3) 确定成本 以及使用 HIVST 指数对男性伴侣进行家庭 ART 与基于设施的 ART 的成本效益。这 试验将为难以接触到的人群提供有关创新艾滋病毒服务提供策略的紧急信息， 比如男人。研究结果预计将为国家政策和国际建议提供信息 结合了跨越艾滋病毒治疗级联的差异化模型。