Developing and Assessing a Male Engagement Intervention in Option B+ in Malawi
Developing and Assessing a Male Engagement Intervention in Option B+ in Malawi: A Randomized Controlled Trial in Lilongwe
調査の概要
詳細な説明
In sub-Saharan Africa, engaging HIV-infected men in HIV care and treatment and engaging HIV-uninfected men in prevention has proven challenging. Along all steps of the HIV care-seeking cascade, men exhibit worse care-seeking behaviors. They are less likely to seek HIV testing and counseling (HTC), initiate combination antiretroviral therapy (cART), and be retained in cART care. Poor care-seeking has resulted in a lower prevalence of viral suppression and earlier mortality. Additionally, men rarely engage in the antenatal care-seeking of their female sexual partners, leading to worse maternal and infant outcomes. This low level of engagement has been noted in Malawi's Option B+ prevention of mother to child transmission (PMTCT) program, and has been a critical barrier to female Option B+ uptake and retention, and a missed opportunity for engaging men.
There is promising evidence that couple-based approaches within Malawi's Option B+ prevention of mother to child transmission program could address all of these challenges: poor male engagement in the HIV continuum of care, low male adoption of biomedical HIV prevention approaches, sub-optimal female engagement in the continuum of care, and poor or uncertain infant outcomes. Our team has designed a couples-based intervention to address these challenges, and will conduct a randomized controlled trial (N=500 couples) to assess intervention effectiveness at one year. Results from this study are expected to inform how best to address family outcomes in an Option B+ program.
This study has the following aims described below:
Aim 1: Determine whether the couple-based intervention increases new HIV-positive diagnoses among HIV-infected male sex partners, helps HIV-infected men engage and remain in care, and contributes to male viral suppression compared to individual standard of care. The investigators will compare the couple-based intervention to standard of care for increasing the proportion of men who are aware of being HIV-infected, the proportion of these men who initiate and remain in cART care, and the proportion of these men with viral suppression at one year.
Aim 2: Determine whether the couple-based intervention identifies HIV-discordant couples and decreases the likelihood of male exposure to HIV compared to individual standard of care. The investigators will compare the intervention to standard of care for increasing the number of men with non-HIV exposure from their female partner through consistent condom use, viral suppression, abstinence, or a combination of these methods over one year.
Aim 3: Determine whether the couple-based intervention improves female cART retention and viral suppression compared to individual standard of care. The investigators will compare the intervention to standard of care for female cART retention and viral suppression at one year.
Aim 4: Determine whether the couple-based intervention improves infant early infant diagnosis uptake compared to individual standard of care. Explore uptake of early infant diagnosis and rates of mother-to-child transmission and child survival in the two intervention arms.
Aim 5: Develop an in-depth understanding of HIV transmission dynamics in Lilongwe. Using the biomarkers and behavioral survey, we will seek to understand transmission timing, direction, and context in Lilongwe. We will compare women with recent HIV infection to a population of HIV-uninfected controls (n=350) to understand predictors of HIV acquisition in pregnancy in Malawi.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Central District
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Lilongwe、Central District、マラウイ
- Bwaila District Hospital Antenatal Unit
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria (HIV-infected Women):
- HIV-infected and eligible for Option B+
- >18 years old or 15-17 years old and married
- Planning to remain in the Bwaila catchment area for the next year or notify the study team if they leave the area or change facilities
Part of a heterosexual relationship for >3 months
- Expects the partner to be in the relevant catchment area for at least one week in the next six months.
- Able and willing to give locator information for this partner
- Willing to have study staff conduct phone and physical tracing of that partner
- Willing to undergo a couple-based intervention with this partner
- Able and willing to provide informed consent
Inclusion Criteria (Male Partners of HIV-infected women)
- >18 years old or 15-17 years old and married
In a relationship with the female partner for >3 months
- Willing to undergo a couples-based intervention with their female partner
- Able and willing to provide informed consent
Inclusion Criteria (HIV-uninfected Women):
- HIV-uninfected
- >18 years old or 15-17 years old and married
Part of a heterosexual relationship for >3 months
- Expects the partner to be in the relevant catchment area for at least one week in the next six months.
- Willing to receive couples-based HIV testing and counseling with this partner
- Able and willing to provide informed consent
Exclusion Criteria (all Women and Male Partners):
• Any condition that in the opinion of the study investigator would compromise the ability of the prospective participant to provide informed consent, undergo study procedures safely, or would prevent proper conduct of the study.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:ヘルスサービス研究
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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介入なし:Individual (SOC)
HIV-infected pregnant women enrolled in the individual arm of the study will receive Standard of Care Option B+ procedures.
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実験的:Couple (Intervention)
In addition to receiving standard of care procedures, HIV-infected pregnant women in the couple arm will be provided with an intervention aimed at recruiting their male partners, providing enhanced couple counseling and testing, engaging their male partners in their care, and supporting male partners to receive care and treatment services.
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Participants are provided study-specific partner referral cards and encouraged to bring male partners to antenatal care for a male engagement intervention. Those who do not present on their own are then traced. Couples will receive three enhanced couple counseling sessions that include: pre-test counseling, return of joint results, and post-test counseling. HIV-infected men will be able to initiate cART at the antenatal clinic and the couple will be offered condoms from the HTC counselor. Between sessions, couple members can pick up condoms and cART for one another.
他の名前:
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介入なし:HIV-Uninfected Cohort
HIV-uninfected pregnant women will be invited to participate in a cross-sectional study.
No intervention will be provided and no follow-up will be conducted.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Number of Women Retained in Care
時間枠:12 months
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Women who presented at 12 months and reported taking at least one dose of ART in the last seven days
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12 months
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Number of Women With Viral Suppression
時間枠:12 months
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Women who presented at 12 months with a viral load <1000 copies/mL
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12 months
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Number of HIV-positive Male Partners Aware of Their HIV-positive Status
時間枠:12 months
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HIV-positive male partners who presented at 12 months and reported knowing they were HIV-positive prior to receiving the results of the HIV test conducted at the 12 month study visit
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12 months
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Number of HIV-positive Male Partners Retained in Care
時間枠:12 months
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HIV-positive male partners who presented at 12 months and reported taking at least one dose of ART in the last seven days
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12 months
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Number of HIV-positive Male Partners With Viral Suppression
時間枠:12 months
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HIV-positive male partners who presented at 12 months with a viral load <1000 copies/mL
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12 months
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Number of HIV-negative Men Without HIV Exposure From Their Primary Partner
時間枠:12 months
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HIV-negative men with a) consistent condom use in the last six months or b) a suppressed female partner or c) abstinence with primary partner
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12 months
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Number of HIV-positive Female Participants Who Reported Early Infant Diagnosis
時間枠:12 months
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HIV-positive female participants who reported a live birth and uptake of early infant diagnosis
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12 months
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Predictors of Recent HIV Infection
時間枠:At the day of female consent
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Risk factor analysis to identify predictors of recent HIV infection among pregnant women
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At the day of female consent
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協力者と研究者
捜査官
- 主任研究者:Nora E Rosenberg, PhD、University of North Carolina, Chapel Hill
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
その他の研究ID番号
- 17-0681
- R00MH104154 (米国 NIH グラント/契約)
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
米国で製造され、米国から輸出された製品。
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