Kariithi Edward, Sharma Monisha, Kemunto Emily, Lagat Harison, Otieno George, Wamuti Beatrice M, Katz David A, Obong'o Christopher, Macharia Paul, Bosire Rose, Masyuko Sarah, Mugambi Mary, Levin Carol E, Liu Wenjia, Roy Paladhi Unmesha, Weiner Bryan J, Farquhar Carey
PATH-Kenya, Kisumu, Kenya.
Department of Global Health, University of Washington, Seattle, WA, United States.
JMIR Res Protoc. 2021 May 20;10(5):e27262. doi: 10.2196/27262.
Despite the effective scale-up of HIV testing and treatment programs, only 75% of people living with HIV (PLWH) globally know their status, and this rate is lower among men. This highlights the importance of implementing HIV testing and linkage interventions with a high uptake in this population. In a cluster randomized controlled trial conducted in Kenya between 2013 and 2015, we found that assisted partner services (APS) for HIV-exposed partners of newly diagnosed PLWH safely reached more HIV-exposed individuals with HIV testing compared with client referral alone. However, more data are needed to evaluate APS implementation in a real-world setting.
This study aims to evaluate the effectiveness, acceptability, fidelity, and cost of APS when integrated into existing HIV testing services (HTS) in Western Kenya.
Our study team from the University of Washington and PATH is integrating APS into 31 health facilities in Western Kenya. We are enrolling females newly diagnosed with HIV (index clients) who consent to receiving APS, their male sexual partners, and female sexual partners of male sexual partners who tested HIV positive. Female index clients and sexual partners testing HIV positive will be followed up at 6 weeks, 6 months, and 12 months postenrollment to assess linkage to care, antiretroviral therapy initiation, and HIV viral load suppression. We will evaluate the acceptability, fidelity, and cost of real-world implementation of APS via in-depth interviews conducted with national, county, and subcounty-level policy makers responsible for HTS. Facility health staff providing HTS and APS, in addition to staff working with the study project team, will also be interviewed. We will also conduct direct observations of facility infrastructure and clinical procedures and extract data from the facilities and county and national databases.
As of March 2020, we have recruited 1724 female index clients, 3201 male partners, and 1585 female partners. We have completed study recruitment as well as 6-week (2936/2973, 98.75%), 6-month (1596/1641, 97.25%), and 12-month (725/797, 90.9%) follow-up visits. Preliminary analyses show that facilities scaling up APS identify approximately 12-18 new HIV-positive males for every 100 men contacted and tested. We are currently completing the remaining follow-up interviews and incorporating an HIV self-testing component into the study in response to the COVID-19 pandemic.
The results will help bridge the gap between clinical research findings and real-world practice and provide guidance regarding optimal strategies for APS integration into routine HIV service delivery.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/27262.
尽管艾滋病毒检测和治疗项目已有效扩大规模，但全球仅有75%的艾滋病毒感染者（PLWH）知晓自己的感染状况，男性知晓率更低。这凸显了在这一人群中实施高接受度的艾滋病毒检测及关联干预措施的重要性。在2013年至2015年于肯尼亚开展的一项整群随机对照试验中，我们发现，与仅进行客户转介相比，为新诊断出的艾滋病毒感染者的艾滋病毒暴露伴侣提供的辅助性伴侣服务（APS）能让更多艾滋病毒暴露个体接受艾滋病毒检测。然而，还需要更多数据来评估APS在实际环境中的实施情况。
本研究旨在评估将APS整合到肯尼亚西部现有艾滋病毒检测服务（HTS）中的有效性、可接受性、保真度和成本。
我们来自华盛顿大学和PATH的研究团队正在将APS整合到肯尼亚西部的31个医疗机构中。我们正在招募新诊断出艾滋病毒感染的女性（索引客户），她们同意接受APS，其男性性伴侣，以及检测艾滋病毒呈阳性的男性性伴侣的女性性伴侣。女性索引客户和检测艾滋病毒呈阳性的性伴侣将在入组后6周、6个月和12个月接受随访，以评估与护理的关联、抗逆转录病毒治疗的启动以及艾滋病毒病毒载量的抑制情况。我们将通过与负责HTS的国家、县和县级以下政策制定者进行深入访谈，评估APS实际实施的可接受性、保真度和成本。除了与研究项目团队合作的工作人员外，提供HTS和APS的医疗机构卫生人员也将接受访谈。我们还将直接观察医疗机构的基础设施和临床程序，并从医疗机构以及县和国家数据库中提取数据。
截至2020年3月，我们已招募了1724名女性索引客户、3201名男性伴侣和
