Leaving no one behind: Identifying approaches to improving HIV treatment outcomes among older Ugandans

不让任何人掉队：确定改善乌干达老年人艾滋病毒治疗结果的方法

• 批准号: MR/N027515/1
• 负责人: Janet Seeley
• 金额: $ 19.18万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN027515%2F1
• 关键词: Leaving; no; behind; Identifying; approaches

The number of people living with HIV in sub-Saharan Africa (SSA) is increasing, as people live longer due to increased access to treatment. Specifically the number of people living with HIV who are aged 50 years or older is predicted to increase from 3.1 million people in 2011 to 9.1 million in 2040. Facilitating older people's access to anti-retroviral therapy (ART) and enabling their ability to adhere to their treatment is key for their own health, and following a 'treatment as prevention' model it is also key to preventing the spread of HIV into the wider population.Older adults have been largely neglected by the prevention community, because the focus has been on reproductive health, mother-to-child transmission, and younger populations where known HIV incidence is high. There is also an ageist driven myth that older adults are not sexually active. Adults remain sexually active well into old age, with the cessation of sexual activity typically resulting from physical health problems and/or the unavailability of a sexual partner which is particularly the case among older women. Studies of HIV-positive older adults in the U.S. find they too remain sexually active, but upwards of 40% do not use condoms regularly; similar results are emerging from research in Africa. Access to ART can protect their own health and reduce their infectivity. Few studies have examined the barriers for older persons to access treatment for HIV, and to adhere to the treatment, and interventions to improve ART access and adherence have not specifically focused on older adults. This project in Uganda will contribute evidence to address a gap in knowledge on older persons' barriers to ART access and adherence in SSA.It is not clear whether barriers and facilitators to ART access and adherence would be the same for older populations as younger populations, or if social interventions that have worked well for other populations would sufficiently address older adults' needs. Older adults' barriers to other health care services in SSA include high rates of poverty limiting money for transport and care; multi-morbidity; ageism; and little understanding among health providers of older persons' needs. Their wellbeing is further implicated by social isolation and HIV-related stigma. This project will be the first to develop a tailored multi-pronged social intervention that identifies and addresses older Africans' barriers to ART access and adherence by addressing needs at the individual, community and health system levels.In this project, we will develop and refine a multi-pronged social intervention to improve access, adherence and wellbeing among older Ugandans. The specific aims of the project are to: (1) Use interviews with older adults, community leaders and health care workers to identify barriers and facilitators to older adults' ART access and adherence. (2a) Develop an intervention that will improve older adults' access and adherence to treatment based on community and older people's perspectives; (2b) Establish a theory of change, i.e., expected factors that will need to be evaluated for change along with the intervention to explain how the intervention works. (3) Refine the intervention by collecting potential clients', community members', and health care providers' perspectives on the intervention's potential, design and the ideal delivery method.This work will help design a future randomized trial which will formally evaluate how effective the intervention is in improving access and adherence to treatment, as well as reducing social isolation among older people living with HIV in Uganda.

撒哈拉以南非洲（SSA）的艾滋病毒感染者人数正在增加，因为人们由于获得治疗的机会增加而寿命延长。具体而言，50岁或以上的艾滋病毒感染者人数预计将从2011年的310万人增加到2040年的910万人。促进老年人获得抗逆转录病毒治疗（ART）并使他们能够坚持治疗是其自身健康的关键，遵循“治疗即预防”模式也是防止艾滋病毒向更广泛人群传播的关键。老年人在很大程度上被预防界忽视，因为重点一直放在生殖健康、母婴传播、艾滋病毒/艾滋病传播和艾滋病传播方面。以及已知艾滋病毒感染率高的年轻人口。还有一个年龄歧视驱动的神话，老年人没有性活跃。成年人在进入老年后仍保持性活跃，性活动的停止通常是由于身体健康问题和/或没有性伴侣，老年妇女的情况尤其如此。对美国艾滋病毒阳性老年人的研究发现，他们也保持性活跃，但超过40%的人不经常使用避孕套;非洲的研究也出现了类似的结果。获得抗逆转录病毒疗法可以保护他们自己的健康，减少他们的传染性。很少有研究审查老年人获得艾滋病毒治疗和坚持治疗的障碍，改善抗逆转录病毒疗法获得和坚持治疗的干预措施没有专门针对老年人。在乌干达的这个项目将提供证据，以解决撒哈拉以南非洲在老年人获得和坚持抗逆转录病毒治疗的障碍方面存在的知识差距，目前尚不清楚老年人获得和坚持抗逆转录病毒治疗的障碍和促进因素是否与年轻人相同，或者对其他人口行之有效的社会干预措施是否足以满足老年人的需求。撒南非洲老年人获得其他保健服务的障碍包括：贫穷率高，交通和护理资金有限;多种疾病;年龄歧视;保健服务提供者对老年人的需求了解甚少。社会孤立和与艾滋病毒有关的耻辱感进一步影响到他们的福祉。该项目将是第一个制定有针对性的多管齐下的社会干预措施的项目，通过解决个人、社区和卫生系统层面的需求，确定和解决非洲老年人获得和坚持抗逆转录病毒治疗的障碍。在该项目中，我们将制定和完善多管齐下的社会干预措施，以改善乌干达老年人的获得、坚持和福祉。该项目的具体目标是：（1）通过与老年人、社区领导人和卫生保健工作者的访谈，确定老年人获得和坚持抗逆转录病毒治疗的障碍和促进因素。(2a)制定一项干预措施，根据社区和老年人的观点，改善老年人获得和坚持治疗的机会;（2b）建立一种改变理论，即，预期因素，这些因素将需要随着干预措施的变化沿着进行评估，以解释干预措施是如何工作的。(3)通过收集潜在客户、社区成员和卫生保健提供者对干预的潜力、设计和理想交付方法的看法来完善干预。这项工作将有助于设计未来的随机试验，正式评估干预在改善治疗的可及性和依从性以及减少乌干达老年艾滋病毒感染者的社会隔离方面的有效性。

项目成果

"We shall have gone to a higher standard": Training village heath teams (VHTs) to use a smartphone-guided intervention to link older Ugandans with hypertension and diabetes to care

“我们应该达到更高的标准”：培训乡村卫生团队 (VHT) 使用智能手机引导的干预措施将患有高血压和糖尿病的乌干达老年人联系起来进行护理

• DOI: 10.12688/aasopenres.13049.1
• 发表时间: 2020
• 期刊: AAS Open Research
• 作者: Mugisha J

Social engagement and survival in people aged 50 years and over living with HIV and without HIV in Uganda: a prospective cohort study.

乌干达 50 岁及以上艾滋病毒感染者和非艾滋病毒感染者的社会参与和生存：一项前瞻性队列研究。

• DOI: 10.2989/16085906.2018.1542322
• 发表时间: 2018
• 期刊: AJAR
• 作者: Mugisha JO

Additional file 1: of â For us here, we remind ourselvesâ : strategies and barriers to ART access and adherence among older Ugandans

附加文件 1：“对于我们来说，我们提醒自己”：乌干达老年人获取和遵守 ART 的策略和障碍

• DOI: 10.6084/m9.figshare.7659566
• 发表时间: 2019
• 作者: Schatz E