[R01] Innovative Tools to Expand Self-Testing and Long-Acting Injectables (I-TEST LAIs) for HIV Treatment and Prevention Among Commercial Minibus Drivers
Ente: National Institute of Allergy and Infectious Diseases
Scadenza: 2029-06-30
Importo max: 581.952 EUR
Paese: US
Descrizione
Commercial minibus drivers constitute a large social network of highly mobile men who work long, demanding
hours, are at increased risk for HIV, and have limited time to seek HIV services. In our preliminary work, our
team found a high HIV seropositivity rate of 12.5% among 407 commercial minibus drivers in Nigeria, nearly
six times the estimated 2.1% national average. Despite high willingness to test HIV, the mobile nature of their
work poses substantial barriers for those living with HIV to initiate and adhere to antiretroviral therapy (ART)
and for those who are HIV-negative and at risk to obtain pre-exposure prophylaxis (PrEP). Therefore,
innovative strategies such as HIV self-testing (HIVST), which allow individuals to test at home or in private, and
long-acting injectable ART (LAI-ART) or LAI-PrEP may work better to address these barriers. This population
can be reached at scale only through Nigeria's motor-park transport system, an organized network of stations
and peer hierarchies with no equivalent in the United States. These epidemiological conditions, combined with
Nigeria's 2023 regulatory approval of long-acting injectable cabotegravir (CAB-LA) for PrEP, create a natural
implementation science laboratory that cannot be replicated in the United States, making Nigeria the
necessary site for this research. Our multidisciplinary team proposes a Type 1 hybrid effectiveness–
implementation study to assess clinical and implementation determinants and outcomes simultaneously. Our
specific aims are: Aim 1: Determine the comparative effectiveness of the I-TEST LAIs intervention versus
standard of care (SoC) on LAI-PrEP uptake and HIV prevention among minibus drivers in Nigeria, and explore
mediating and moderating factors influencing primary and secondary outcomes. Aim 2: Determine the
effectiveness of I-TEST LAIs versus SoC on LAI-ART uptake, retention in care, and viral suppression among
minibus drivers living with HIV with viral suppression (VL below 1000 HIV RNA copies/mL) and explore
mediating and moderating factors. Aim 3: Assess determinants of implementation and estimate costeffectiveness
to inform scale-up and dissemination. Through a reciprocal-innovation framework, the peer-led,
mobile-friendly delivery strategies, implementation determinants, and cost-effectiveness evidence generated
here are directly transferable to analogous hard-to-reach US populations, including long-haul truckers and men
in the rural US South, and will inform US scale-up of long-acting injectables in Ending the HIV Epidemic priority
jurisdictions, advancing HIV prevention and care. All research leadership, data analysis, and intellectual
property reside at George Washington University in Washington, DC.
Istituzione: GEORGE WASHINGTON UNIVERSITY
PI: Donaldson Conserve, Ucheoma Catherine Nwaozuru
Progetto: 5R01AI186786-03
Settori: National Institute of Allergy and Infectious Diseases
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