Utilization of Decentralized HIV Clinical Services in Rural Maharashtra, India

描述(由申请者提供)：印度是全球艾滋病毒感染人数最多的国家。中国60%的艾滋病毒病例发生在农村居民中，但目前还没有为他们提供艾滋病毒检测或护理服务的系统。吉塔·辛哈博士的研究和职业生涯将解决如何以最佳方式诊断和治疗印度农村艾滋病毒感染者的问题。作为约翰·霍普金斯大学的传染病研究员，她进行了一项有指导的初步研究，确定了印度马哈拉施特拉邦农村地区艾滋病毒检测利用率低和检测障碍，马哈拉施特拉邦是艾滋病毒高发地区。利用初步数据和社会生态学理论的要素，她帮助设计了一种新的模式，即以农村诊所为基础的艾滋病毒检测和护理服务。在IRSDA的支持下，辛哈博士作为霍普金斯大学的一名指导教师，将在马哈拉施特拉邦的两个农村地区进行一项以社区为基础的临床试验，比较完全分散的艾滋病毒服务干预模式和政府的部分分散控制模式的利用情况，后者提供农村检测和基于城市的护理。在头两年，她将对社区居民进行年度横断面研究，并使用定性访谈来评估社区中任何类型艾滋病毒检测的使用变化和特点。她将计算使用率，并进行一项以诊所为基础的年度横断面研究，以评估特定分散的艾滋病毒检测在诊所就诊者中的使用情况和特点。在第三年，她将进行临床访谈和数据提取，以比较每个模型中农村艾滋病毒确诊患者的护理服务利用率和短期临床结果。在印度-美国合作艾滋病毒临床研究的领导者Robert Bellinger博士、国际资助的农村卫生服务研究组织Pachod(IHMP)健康管理研究所主任Ashok Dyalchand博士的指导下，在Shruti Mehta博士、David Peters、Michael Sweat和Kelly Gebo博士的多学科联合建议下，Sinha博士还将把公共卫生学院的流行病学、卫生服务研究和健康行为课程直接应用到她的研究中，并花费大量时间在印度农村完成她的研究。印度农村独特的IHMP研究环境、出色的印美机构合作和指导以及多学科课程将帮助Sinha博士发展成为一名研究印度农村地区艾滋病毒服务和临床结果的独立调查员。

DESCRIPTION (provided by applicant): India has the highest estimated number of HIV cases globally. Sixty percent of its HIV cases occur in rural residents, yet there is currently no system of HIV testing or care services for them. Dr. Gita Sinha's research and career will address the question of how to optimally diagnose and treat rural Indians with HIV. As an Infectious Diseases fellow at Johns Hopkins University, she has conducted a mentored preliminary study identifying low HIV testing utilization and barriers to testing in rural Maharashtra, India, a high-HIV prevalent setting. Using preliminary data and elements of social ecological theory, she has helped design a novel model of "fully-decentralized," or rural clinic-based, HIV testing and care services. With IRSDA support, Dr. Sinha, as a mentored Hopkins faculty member, will conduct a community-based clinical trial in two rural Maharashtra districts, comparing utilization of the fully-decentralized HIV services intervention model with the government's partially-decentralized control model, which offers rural testing and urban-based care. Over the first two years, she will conduct an annual cross-sectional study of community residents and use qualitative interviews to assess changes in and characteristics of utilization of any type of HIV testing in the community. She will calculate utilization rates and conduct an annual clinic-based cross-sectional study to assess changes in and characteristics of specific decentralized HIV testing utilization among clinic attendees. In the third year, she will conduct clinical interviews and data extraction to compare care services utilization and short-term clinical outcomes among rural HIV-diagnosed individuals in each model. Mentored by Dr. Robert Bellinger, a leader in Indo-U.S. collaborative HIV clinical research in India, Dr. Ashok Dyalchand, director of the Institute of Health Management, Pachod (IHMP), an internationally-funded rural health services research organization, and with multi-disciplinary co-advising from Drs.Shruti Mehta, David Peters , Michael Sweat, and Kelly Gebo, Dr. Sinha will also apply School of Public Health courses in Epidemiology, Health Services Research, and Health Behavior directly to her research, and spend significant time in rural India to complete her study. The unique IHMP rural India research environment, outstanding Indo-U.S. institutional collaboration and mentorship, and multi-disciplinary coursework will help Dr. Sinha evolve into an independent investigator studying HIV services and clinical outcomes in rural India.