Armstrong-Hough Mari, Gupta Amanda J, Ggita Joseph, Nangendo Joan, Katamba Achilles, Davis J Lucian
medRxiv. 2024 May 3:2024.05.02.24306703. doi: 10.1101/2024.05.02.24306703.
HIV status awareness and linkage to care are critical for ending the HIV epidemic and preventing tuberculosis (TB). Among household contacts of persons with TB, HIV greatly increases the risk of incident TB and death. However, almost half of household contacts in routine settings decline HIV test offers during routine contact investigation. We evaluated a brief social-behavioral norming intervention to increase acceptance of HIV testing during household TB contact investigation.
We carried out a household-randomized, controlled trial to evaluate the effect of the norming strategy among household contacts of persons with pulmonary TB in Kampala, Uganda ( ClinicalTrials.gov # NCT05124665 ). Community health workers (CHW) visited homes of persons with TB to screen contacts for TB symptoms and offer free, optional, oral HIV testing. Households were randomized (1:1) to usual care or the norming strategy. Contacts were eligible if they were ≥ 15 years old, self-reported to be HIV-negative, and living in a multi-contact household. The primary outcome, the proportion of contacts accepting HIV testing, was analyzed using an intention-to-treat approach, using a mixed-effects model to account for clustering by household. We assessed HIV testing yield as a proportion of all contacts tested.
We randomized 328 contacts in 99 index households to the norming strategy, of whom 285 (87%) contacts were eligible. We randomized 224 contacts in 86 index households to the usual strategy, of whom 187 (84%) contacts were eligible. Acceptance of HIV testing was higher in the intervention arm (98% versus 92%, difference +6%, 95%CI +2% to +10%, p=0.004). Yield of HIV testing was 2.1% in the intervention arm and 0.6% in the control arm (p=0.22).
A norming intervention significantly improved uptake of HIV testing among household contacts of persons with TB.
FUNDING/SUPPORT: This work was supported by the Center for Interdisciplinary Research on AIDS (P30MH062294) and the Fogarty International Center of the National Institutes of Health (R21TW011270). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or other sponsors.
了解艾滋病毒感染状况并获得治疗对于终结艾滋病毒流行和预防结核病至关重要。在结核病患者的家庭接触者中，艾滋病毒会大大增加感染结核病和死亡的风险。然而，在常规接触者调查中，几乎一半的家庭接触者会拒绝艾滋病毒检测。我们评估了一种简短的社会行为规范干预措施，以提高家庭结核病接触者调查期间对艾滋病毒检测的接受度。
我们在乌干达坎帕拉开展了一项家庭随机对照试验，以评估规范策略对肺结核患者家庭接触者的效果（ClinicalTrials.gov # NCT05124665）。社区卫生工作者（CHW）走访结核病患者家庭，筛查接触者的结核病症状，并提供免费、可选的口服艾滋病毒检测。家庭被随机分为（1:1）常规护理组或规范策略组。接触者年龄≥15岁、自我报告为艾滋病毒阴性且生活在多接触者家庭中即为 eligible。主要结局是接受艾滋病毒检测的接触者比例，采用意向性分析方法，使用混合效应模型来考虑家庭聚类情况。我们将艾滋病毒检测阳性率评估为所有接受检测的接触者的比例。
我们将99个索引家庭中的328名接触者随机分为规范策略组，其中285名（87%）接触者符合条件。我们将86个索引家庭中的224名接触者随机分为常规策略组，其中187名（84%）接触者符合条件。干预组接受艾滋病毒检测的比例更高（98%对92%，差异为+6%，95%CI为+2%至+10%，p = 0.004）。干预组的艾滋病毒检测阳性率为2.1%，对照组为0.6%（p = 0.22）。
规范干预显著提高了结核病患者家庭接触者对艾滋病毒检测的接受度。
资助/支持：这项工作得到了艾滋病跨学科研究中心（P30MH062294）和美国国立卫生研究院福格蒂国际中心（R21TW011270）的支持。内容完全由作者负责，不一定代表美国国立卫生研究院或其他赞助商的官方观点。
