Chang Larry W, Mbabali Ismail, Kong Xiangrong, Hutton Heidi, Amico K Rivet, Kennedy Caitlin E, Nalugoda Fred, Serwadda David, Bollinger Robert C, Quinn Thomas C, Reynolds Steven J, Gray Ronald, Wawer Maria, Nakigozi Gertrude
Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Trials. 2017 Oct 23;18(1):494. doi: 10.1186/s13063-017-2243-6.
Effective yet practical strategies are needed to increase engagement in HIV treatment and prevention services, particularly in high-HIV-prevalence hotspots. We designed a community-based intervention called "Health Scouts" to promote uptake and adherence to HIV services in a highly HIV-prevalent fishing community in Rakai, Uganda. Using a situated Information, Motivation, and Behavioral skills theory framework, the intervention consists of community health workers, called Health Scouts, who use motivational interviewing strategies and mobile health tools to promote engagement in HIV treatment and prevention services.
METHODS/DESIGN: The Health Scout intervention is being evaluated through a pragmatic, parallel, cluster-randomized controlled trial with an allocation ratio of 1:1. The study setting is a single high-HIV-prevalence fishing community in Rakai, Uganda divided into 40 contiguous neighborhood clusters each containing about 65 households. Twenty clusters received the Health Scout Intervention; 20 clusters received standard of care. The Health Scout intervention is delivered within the community at the household level, targeting all residents aged 15 years or older. The primary programmatic outcomes are self-reported HIV care, antiretroviral therapy, and male circumcision coverage; the primary biologic outcome is population-level HIV viremia prevalence. Follow-up is planned for about 3 years.
HIV treatment and prevention service engagement remains suboptimal in HIV hotspots. New, community-based implementation approaches are needed. If found to be effective in this trial, the Health Scout intervention may be an important component of a comprehensive HIV response.
ClinicalTrials.gov, ID: NCT02556957 . Registered on 20 September 2015.
需要有效且实用的策略来提高对艾滋病毒治疗和预防服务的参与度，尤其是在艾滋病毒高流行热点地区。我们设计了一项名为“健康侦察兵”的社区干预措施，以促进乌干达拉凯一个艾滋病毒高流行的渔业社区对艾滋病毒服务的接受和坚持。该干预措施采用情境化的信息、动机和行为技能理论框架，由称为“健康侦察兵”的社区卫生工作者组成，他们使用动机性访谈策略和移动健康工具来促进对艾滋病毒治疗和预防服务的参与。
方法/设计：通过一项务实的、平行的、整群随机对照试验对“健康侦察兵”干预措施进行评估，分配比例为1:1。研究地点是乌干达拉凯一个单一的艾滋病毒高流行渔业社区，分为40个相邻的邻里集群，每个集群约有65户家庭。20个集群接受“健康侦察兵”干预；20个集群接受标准护理。“健康侦察兵”干预在社区内家庭层面实施，目标是所有年龄在15岁及以上的居民。主要的项目成果是自我报告的艾滋病毒护理、抗逆转录病毒治疗和包皮环切术覆盖率；主要的生物学成果是人群层面的艾滋病毒病毒血症患病率。计划进行约3年的随访。
在艾滋病毒热点地区，艾滋病毒治疗和预防服务的参与度仍然不理想。需要新的基于社区的实施方法。如果在该试验中被证明有效，“健康侦察兵”干预可能是全面艾滋病毒应对措施的重要组成部分。
ClinicalTrials.gov，标识符：NCT02556957。于2015年9月20日注册。
