Building capacity for patient-centered outcomes research to improve the quality and impact of HIV care in Tanzania

摘要 在过去10年中，坦桑尼亚取得了重大进展，将抗逆转录病毒治疗(ART)扩大到 140万艾滋病毒携带者(PLWH)。随着获得这些救命疗法的机会增加，PLWH在 坦桑尼亚人的寿命延长了，对卫生系统提出了挑战，以提供长期有效的艾滋病毒护理和 治疗，确保坚持抗逆转录病毒治疗和保留，并适当管理慢性合并症 患有慢性病的PLWH人数不断增加。满足这一需求将需要重新设计艾滋病毒和 提供初级保健服务。以患者为中心的护理(PCC)是高质量护理的重要组成部分。 定义为提供尊重并响应患者个人偏好、需求和需求的护理 价值观，PCC对低收入和中等收入国家(LMIC)至关重要，例如坦桑尼亚 人口结构正在从更严重的疾病转变为慢性病。越来越多的关于艾滋病毒的文献表明， PCC在改善患者艺术和就诊依从性、满意度和生活质量方面的作用。以患者为中心 结果研究(PCOR)旨在研究如何组织卫生系统和护理提供 确保PCC并改善临床和患者报告的结果，这些结果与患者及其 照顾者。在这笔赠款中，我们建议加强坦桑尼亚穆亨比利大学的方案和改革方案能力。 健康和相关科学(MUHAS)艾滋病毒研究社区，长期目标是将 将学科纳入研究，以优化达累斯萨拉姆艾滋病毒设施中的PCC，并改善患者和健康 系统结果。MUHAS在美国国立卫生研究院资助的艾滋病毒研究培训项目中有成功的记录 拥有多个艾滋病毒学科和社会专业知识的优秀艾滋病毒调查人员队伍日益壮大 行为科学。我们在艾滋病毒和PCOR方面的新型研究培训计划将支持短期、中期和 长期培训与导师指导和课程设计能力建设相结合，以实现 以下目标和可持续发展计划：目标1.建设艾滋病毒监测和监测机构的能力和专门知识 研究人员在坦桑尼亚设计和进行艾滋病毒的PCOR；目标2.发展一支教职员工领导和 MUHAS的导师能够为新的艾滋病毒/PCOR调查员提供指导和培训，并维持 变革和组织振兴方案科学议程；和目标3.通过将变革和组织振兴方案正式纳入，推动国内艾滋病毒和变革管理方案议程 将课程纳入现有的研究生学位课程。这笔赠款将支持6名博士后研究员、2名硕士和 2博士生参加长期和中期的PCOR培训。短期方案和改革方案技能建设、指导 教学和课程设计讲习班将培训100多名参与者，内容涉及方案和改革方案、导师制和 教书。一年一度的研讨会将为更广泛的艾滋病毒调查人员提供机会 传播他们的研究并形成新的合作关系。通过这个项目，我们将全面实现 目标是培训新一代独立的坦桑尼亚艾滋病毒/PCOR调查员，指导他们 这是一条独立之路，并带头使MUHAS成为坦桑尼亚变革和组织振兴方案的卓越中心。

Abstract Over the last 10 years, Tanzania has made significant progress expanding antiretroviral treatment (ART) to the 1.4 million people living with HIV (PLWH). With improved access to these life-saving therapies, PLWH in Tanzania are living longer, challenging the health system to provide long-term effective HIV care and treatment, ensure adherence to ART and retention, and adequately manage chronic co-morbidities in the growing number of PLWH with chronic disease. Meeting this demand will require a redesign of how HIV and primary care are delivered. Patient centered care (PCC) is an essential component of high quality care. Defined as `providing care that is respectful of, and responsive to, individual patient preferences, needs and values', PCC is critical to low and middle-income countries (LMICs) such as Tanzania where the health demographic is changing from more acute to chronic disease. A growing literature in HIV has shown the crucial role of PCC in improving patient ART and visit adherence, satisfaction and quality of life. Patient centered outcomes research (PCOR) is designed to study how health systems and care delivery should be organized to ensure PCC and improve clinical and patient-reported outcomes that are most relevant to patients and their caregivers. In this grant, we propose to strengthen the PCOR capacity of the Tanzanian Muhimbili University of Health and Allied Sciences (MUHAS) HIV research community with a long-term goal of incorporating this discipline into studies to optimize PCC in HIV facilities in Dar es Salaam, and improve patient and health system outcomes. MUHAS has a successful track record of NIH-funded research training programs in HIV with a growing faculty of accomplished HIV investigators with expertise in several HIV disciplines and socio- behavioral sciences. Our novel research training program in HIV and PCOR will support short, medium and long-term trainings combined with capacity building in mentorship and curriculum design to achieve the following aims and plan for sustainability: Aim 1. Build the capacity and expertise in MUHAS HIV researchers to design and conduct PCOR in HIV in Tanzania; Aim 2. Develop a team of faculty leaders and mentors at MUHAS able to provide mentorship and training for new HIV PCOR investigators and sustain the PCOR scientific agenda; and Aim 3. Advance the in-country HIV PCOR agenda by formally integrating PCOR courses into existing graduate degree programs. This grant will support 6 post-doctoral fellows, 2 Masters and 2 Ph.D. students through long and medium-term PCOR trainings. Short-term PCOR skills building, mentorship and teaching and curriculum design workshops will train over 100 participants in PCOR, mentorship and teaching. Annual symposia will provide opportunities for the broader community of HIV investigators to disseminate their research and form new collaborations. Through this program we will achieve the overall goal of training a new generation of independent Tanzanian HIV PCOR investigators, mentoring them on the path to independence and leading the way for MUHAS to become a center of excellence in PCOR in Tanzania.