Self-Conducted HIV Tests - Improving HIV Prevention in Key Populations

自行进行艾滋病毒检测——改善重点人群的艾滋病毒预防

• 批准号: 8898221
• 负责人: Sheri Ann Lippman
• 金额: $ 17.71万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8898221
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adoption; Africa South of the Sahara; African; Attitude; Behavior; Behavioral; Blood; Caring; Clinic; Communities; Controlled Environment; Counseling; Country; Data; Decision Making; Detection; Discrimination; Early Diagnosis; Enrollment; Ensure; Epidemic; Ethnography; Fingers; Frequencies; Fright; General Population; Government; Government Programs; HIV; HIV Infections; HIV Seropositivity; Health Personnel; High Prevalence; Human immunodeficiency virus test; Individual; Infection; Intervention; Life; Light; Liquid substance; Oral; Pattern; Persons; Pharmacy facility; Phase; Pilot Projects; Population; Prevalence; Prevention; Prevention program; Prevention strategy; Province; Recruitment Activity; Research; Risk; Risk Behaviors; Risk Reduction; Safe Sex; Services; Sexual Transmission; South Africa; Stigmatization; Surveys; Test Result; Testing; United States National Institutes of Health; base; burden of illness; cohort; condoms; experience; falls; follow-up; high risk; high risk sexual behavior; improved; men; men who have sex with men; preference; programs; public health relevance; sex; sex risk; social stigma; surveillance data; treatment program; uptake

DESCRIPTION (provided by applicant): HIV testing can decrease risky sexual behavior among HIV-positive men who have sex with men (MSM) and provide a gateway into HIV/AIDS care and treatment. MSM in South Africa, however, do not currently utilize clinic-based HIV testing at a rate commensurate with their risk and too few know their status. In South Africa programs have largely failed to engage Men who have Sex with Men (MSM): a population with an extremely high burden of disease and high rates undiagnosed HIV infections. Recent bio-behavioral surveillance data undertaken by this investigative team in Mpumalanga Province demonstrated prevalence among MSM at above 30%, with 54% of HIV positive MSM unaware of their status prior to survey participation. Urgently needed strategies to expand HIV testing among MSM in South Africa may include new HIV self-testing kits that offer an alternative to clinic-based testing. Self-tests expand testing beyond the clinic, which is of particular significance for MSM and other key populations who require more frequent testing and are less comfortable accessing clinic services. While self-conducted HIV tests could expand the package of testing options in South Africa, thus facilitating earlier HIV detection and treatment, there isa lack of information regarding acceptability, feasibility, or potential behavioral impacts of introducing the HIV self-test among African MSM. To address this gap, we propose to determine the acceptability (Aim 1), the feasibility (Aim 2) and the behavioral impacts (aim 3) of HIV self-testing among South African MSM currently enrolled in NIH-sponsored cohorts (R01AI092892, Lane). We will explore whether self-testing will be used by South African MSM; how, when, where, what kind, and with whom self-tests are utilized; how sexual risk behaviors may be modified by introducing self-test kits into this community; and strategies to ensure linkage to care following self-testing in this underserved and high risk population. We will achieve these aims by first conducting a pre-pilot study to explore initial acceptability of both blood-based and oral fluid self-tests and to understand what is necessary to ensure safe and correct usage of both self-tests in a controlled environment. We will then conduct a pilot study, where we will distribute self-testing kits to HIV-negative MSM and follow their use over the course of 6 months. We will implement this study among MSM participating in cohorts recruited from the high prevalence Gert Sibande and Ehlanzeni districts. This proposal offers a unique opportunity to explore self-testing among MSM within established NIH-supported cohorts where a productive research partnership is already underway. The proposed research will provide information critical to understanding how self-tests would fit into a package of expanded testing options for high risk communities experiencing barriers to clinic-based testing and support future research to determine whether introduction of self-testing can improve early detection and entry to care and facilitate safer sexual behaviors, thus leading to prevention gains.

描述（由申请人提供）：HIV 检测可以减少男男性行为者 (MSM) 的 HIV 阳性男性的危险性行为，并为 HIV/艾滋病护理和治疗提供途径。然而，南非的男同性恋者目前并未按照与其风险相称的速度利用基于临床的艾滋病毒检测，而且很少有人知道他们的状况。在南非，相关项目在很大程度上未能吸引男男性行为者 (MSM)：这一人群的疾病负担极高，未确诊的艾滋病毒感染率也很高。该调查小组最近在普马兰加省进行的生物行为监测数据显示，MSM 的患病率超过 30%，其中 54% 的 HIV 阳性 MSM 在参与调查之前不知道自己的状况。扩大南非 MSM 艾滋病毒检测的迫切需要策略可能包括新的艾滋病毒自我检测试剂盒，为临床检测提供替代方案。自检将检测范围扩大到诊所之外，这对于 MSM 和其他需要更频繁检测且不太愿意接受诊所服务的重点人群尤其重要。虽然自我进行的艾滋病毒检测可以扩大南非的检测选择范围，从而促进艾滋病毒的早期检测和治疗，但缺乏关于在非洲男男性行为者中引入艾滋病毒自检的可接受性、可行性或潜在行为影响的信息。为了解决这一差距，我们建议确定目前参加 NIH 赞助队列的南非 MSM 中 HIV 自我检测的可接受性（目标 1）、可行性（目标 2）和行为影响（目标 3）（R01AI092892，Lane） ）。我们将探讨南非MSM是否会使用自我测试；如何、何时、何地、何种类型以及与谁一起进行自测；如何通过向该社区引入自检套件来改变性危险行为；确保在这一服务不足和高风险人群中进行自我检测后与护理联系起来的策略。我们将通过首先进行预试点研究来探索基于血液和基于血液的药物的初步可接受性来实现这些目标。 口腔液自检，并了解确保在受控环境中安全和正确使用两种自检所需的必要条件。然后，我们将进行一项试点研究，向 HIV 阴性 MSM 分发自我检测试剂盒，并在 6 个月的时间内跟踪其使用情况。我们将在参与从高流行率 Gert Sibande 和 Ehlanzeni 地区招募的队列的 MSM 中实施这项研究。该提案提供了一个独特的机会，可以在 NIH 支持的既定队列中探索 MSM 的自我测试，而富有成效的研究伙伴关系已经在进行中。拟议的研究将提供对于了解自我测试如何适应临床测试障碍的高风险社区的一系列扩展测试选项至关重要的信息，并支持未来的研究，以确定自我测试的引入是否可以改善早期检测和预防。获得护理并促进更安全的性行为，从而取得预防成果。