Feasibility and acceptability of Enhanced Patient Care (EPC) for adult HIV patients with unsuppressed viral loads in western Kenya

针对肯尼亚西部病毒载量未抑制的成年 HIV 患者实施强化患者护理 (EPC) 的可行性和可接受性

• 批准号: 10312738
• 负责人: Juddy Wachira
• 金额: $ 11.06万
• 依托单位: MOI UNIVERSITY COLLEGE OF HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-15 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10312738
• 关键词: Achievement; Address; Adherence; Adult; Africa South of the Sahara; American; Appointment; Award; Biometry; Caring; Chronic Disease; Clinic; Clinical; Clinical Research; Collaborations; Communication; Continuity of Patient Care; Control Groups; Cost utility; Data; Developed Countries; Educational process of instructing; Elements; Environment; Epidemiology; Foundations; Funding Opportunities; Future; Goals; Grant; HIV; HIV Infections; Health; Health Professional; Health Sciences; Health care facility; Healthcare Systems; Hospital Referrals; Hour; Individual; Intervention; Investments; Kenya; Lead; Measures; Medical Records; Mentors; Mentorship; Methodology; Methods; Modeling; North America; Outcome; Patient Care; Patient-Centered Care; Patients; Persons; Positioning Attribute; Provider; Research; Research Methodology; Research Personnel; Resource-limited setting; Schedule; System; Time; Training; Treatment outcome; Universities; Ursidae Family; Viral; Viral Load result; Wait Time; Work; acceptability and feasibility; adherence rate; antiretroviral therapy; barrier to care; care systems; career; college; compliance behavior; cost; cost effective; cost effectiveness; design; directed attention; economic evaluation; evidence base; experience; health care availability; implementation science; improved; medication compliance; multilevel analysis; negative affect; operation; pandemic disease; patient engagement; patient oriented; patient-clinician communication; programs; service delivery; skills; sound; standard care; standard of care; success; system-level barriers; therapy adherence; treatment arm; uptake

PROJECT SUMMARY Sub-Saharan Africa (SSA) has made tremendous strides in the provision and uptake of antiretroviral therapy (ART) among HIV-infected persons. Despite these advancements, the region continues to experience low rates of adherence and retention along the cascade of HIV care. Initiating effective ART adherence dialogue with patients while incorporating patient-specific interventions along the continuum of care is key to improving patient engagement in HIV care. Unfortunately, system-level factors such as long waiting times, staff shortages, lack of continuity in provider- patient relationship, poor provider communication skills, and inconvenient clinic hours create barriers to ART adherence. Addressing these system-level barriers is fundamental to provide a conducive patient-centered care system that help patients adhere to ART and overcome other interpersonal and individual barriers to care. My long-term goal is to become an independent implementation science researcher who successfully develops, implements and evaluates multilevel interventions to address system-level barriers to patient engagement in HIV care. This K43 will provide me with the additional training and preliminary data necessary to achieve these research goals. My training will focus on: 1. Implementation science, 2. Advanced quantitative research methods, and 3. Economic evaluation of health interventions. To accomplish this, I will draw from the expertise of my mentorship team lead by primary mentors Drs. Ira Wilson (Brown University, USA) and Abraham Siika (Moi University, Kenya), both of whom have a wealth of experience mentoring junior investigators. My mentorship team is comprised of health professionals who have expertise in clinical research, implementation science, patient-centered care, epidemiology, biostatistics, and economic evaluation of interventions in HIV care settings. The award and completion of this K43 grant will provide me with a strong foundation to compete for an R01 in collaboration with other experienced investigators to extend my research to focus on multi- level approaches to promote patient engagement in care within a patient-centered framework that incorporates other chronic diseases. My prior training, research experience, and mentorship team, places me in a strategic position to achieve my research goals.

项目摘要 撒哈拉以南非洲在提供和接受抗逆转录病毒疗法方面取得了巨大进展 在艾滋病毒感染者中。尽管取得了这些进展，但该区域的遵守率仍然很低 并保持沿着艾滋病护理的阶梯。与患者开展有效的ART依从性对话， 将针对患者的干预措施沿着整个护理过程，是提高患者参与艾滋病毒治疗的关键 在乎不幸的是，系统层面的因素，如等待时间长，工作人员短缺，缺乏连续性的供应商- 患者关系、较差的提供者沟通技巧和不方便的门诊时间为ART造成了障碍 坚持。解决这些系统层面的障碍是提供一个有益的以病人为中心的护理系统的基础 帮助患者坚持ART并克服其他人际和个人护理障碍。我的长期目标是 成为一个独立的实施科学研究人员谁成功地开发，实施和评估 多层次干预措施，以解决系统层面的障碍，病人参与艾滋病毒护理。这辆K43能让我 与额外的培训和必要的初步数据，以实现这些研究目标。我的培训将集中在：1。 执行科学，2。先进的定量研究方法，3。卫生经济评价 干预措施。为了实现这一目标，我将利用由主要导师伊拉博士领导的导师团队的专业知识 威尔逊（美国布朗大学）和亚伯拉罕·西卡（肯尼亚莫伊大学），两人都有丰富的经验 指导初级调查员我的导师团队由具有临床专业知识的卫生专业人员组成， 研究，实施科学，以病人为中心的护理，流行病学，生物统计学和经济评估， 艾滋病毒护理环境中的干预措施。这个K43补助金的授予和完成将为我提供一个坚实的基础 与其他经验丰富的研究人员合作，竞争R 01，以扩展我的研究，重点是多方面的， 在以患者为中心的框架内促进患者参与护理的水平方法， 慢性病我之前的培训，研究经验和导师团队，使我处于战略地位， 实现我的研究目标。