Foundation for Professional Development, Health Systems Strengthening Division, Pretoria, South Africa.
University of the Witwatersrand, School of Public Health, Johannesburg, South Africa.
BMC Public Health. 2020 Jan 29;20(1):118. doi: 10.1186/s12889-020-8231-x.
Meeting the ambitious UN 90-90-90 HIV testing, treatment and viral load suppression targets requires innovative strategies and approaches in Sub-Saharan Africa. To date no known interventions have been tested with community health workers (counsellors) as social franchisees or owner-managed businesses in Community-based HIV counselling and testing (CBCT) work. The aim of this methods paper is to describe a Social franchise (SF) CBCT implementation trial to increase HIV testing and linkage to care for individuals at community levels in comparison with an existing CBCT programme methods.
METHODS/DESIGN: This is a two arm non-randomised community implementation trial with a once off round of post-test follow-up per HIV positive participant to assess linkage to care in low income communities. The intervention arm is a social franchise CBCT in which unemployed, self-employed or employed community members are recruited, contracted and incentivised to test at least 100 people per month, identifying at least 5 HIV positive tests and linking to care at least 4 of them. Social franchisees receive approximately $3.20 per HIV test and $8 per client linked to care. In the control arm, full-time employed HIV counsellors conduct CBCT on a fixed monthly salary. Primary study outcomes are HIV testing uptake rate, HIV positivity, Linkage to care and treatment rate and average counsellors' remuneration cost. Data collection will be conducted using both paper-based and electronic data applications by CBCT or SF counsellors. Data analysis will compare proportions of HIV testing, positivity, linkage to HIV care and treatment rates and counsellors' cost in the two study arms.
The study will provide important insight into whether the SF-delivered CBCT programme increases testing coverage and linkage to care as well as reducing CBCT cost per HIV test and per HIV positive person linked to care.
Pan African Clinical Trial Registry PACTR201809873079121. The trial was retrospectively registered on 11 September 2018.
在撒哈拉以南非洲地区，要实现联合国 90-90-90 艾滋病毒检测、治疗和病毒载量抑制目标，需要创新的战略和方法。迄今为止，还没有已知的干预措施在社区卫生工作者（咨询员）作为社会特许经营商或自有企业的社区艾滋病咨询和检测（CBCT）工作中进行过测试。本文的目的是描述一项社会特许经营（SF）CBCT 实施试验，以与现有的 CBCT 方案方法相比，提高社区一级的艾滋病毒检测和与护理的联系，从而实现这一目标。
方法/设计：这是一项两臂非随机社区实施试验，对每一位艾滋病毒阳性参与者进行一次性的检测后随访，以评估低收入社区的护理联系情况。干预组是一个社会特许经营 CBCT，招募失业、自营或受雇的社区成员，签订合同并激励他们每月至少检测 100 人，至少发现 5 例艾滋病毒阳性检测，并至少将其中 4 例与护理联系起来。社会特许经营商每进行一次艾滋病毒检测可获得约 3.20 美元，每联系到一名接受护理的患者可获得 8 美元。在对照组中，全职艾滋病毒咨询员按照固定月薪进行 CBCT。主要研究结果是艾滋病毒检测率、艾滋病毒阳性率、与护理的联系率和治疗率以及平均咨询员薪酬成本。CBCT 或 SF 咨询员将使用纸质和电子数据应用程序进行数据收集。数据分析将比较两个研究组中艾滋病毒检测、阳性率、与艾滋病毒护理的联系率和治疗率以及咨询员成本的比例。
该研究将为 SF 提供的 CBCT 方案是否能提高检测覆盖面和与护理的联系，以及降低每艾滋病毒检测和每与护理联系的艾滋病毒阳性者的 CBCT 成本提供重要见解。
泛非临床试验注册处 PACTR201809873079121。该试验于 2018 年 9 月 11 日回顾性注册。
