Pathways to Engagement in HIV-Care for Newly-Diagnosed South Africans

新确诊南非人参与艾滋病毒护理的途径

• 批准号: 8074932
• 负责人: Susie Hoffman
• 金额: $ 57.4万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8074932
• 关键词: AIDS prevention; Address; Adherence; Affect; Africa South of the Sahara; African; Applications Grants; Area; Attention; Behavior; Behavioral; Belief; Caring; Cognitive; Cohort Studies; Communities; Community Health Services; Counseling; Critiques; Data; Decision Making; Developing Countries; Development; Diagnosis; Disclosure; Disease; Educational workshop; Effectiveness; Eligibility Determination; Enrollment; Ensure; Environment; Equipment and supply inventories; Feedback; Foundations; Gender; Goals; HIV; HIV diagnosis; HIV prevention trial; Health; Health Personnel; Health Services; Health Services Accessibility; Health system; Human immunodeficiency virus test; Incidence; Individual; Inequality; International; Intervention; Interview; Knowledge; Learning; Left; Link; Maps; Mental Health; Modality; Motivation; Newly Diagnosed; Outcome; Participant; Pathway interactions; Personal Satisfaction; Persons; Play; Policies; Positioning Attribute; Poverty; Prevalence; Primary Health Care; Process; Professional counselor; Prospective Studies; Provider; Relative (related person); Research; Resources; Risk; Sampling; Screening procedure; Services; Sexual Transmission; Shapes; Social Sciences; South Africa; Staging; Stigmata; Structure; Testing; Time; Vertical Disease Transmission; Woman; Women' s Health; Work; antiretroviral therapy; base; care seeking; care systems; cohort; community organizations; coping; experience; follow-up; improved; innovation; insight; interest; member; men; microbicide; novel; programs; prospective; psychosocial; reproductive; response; scale up; social; social cognition; social organization; social stigma; theories; therapy development; treatment adherence; treatment program

DESCRIPTION (provided by applicant): With the global effort to scale-up treatment programs and increase access to antiretroviral therapy (ART) for HIV+ people in resource-constrained nations, it is vital to understand how people become linked to HIV primary care, as many are entering care too late to benefit from ART. There is now significant momentum to promote HIV testing as a way to increase early enrollment in care, but relatively little attention to address the period immediately after a person receives an HIV+ diagnosis. As most studies of HIV+ individuals have been conducted among those already enrolled in care, there is limited knowledge concerning facilitators of and impediments to enrolling in HIV primary care and care-seeking more generally among those newly-diagnosed. The proposed four-year study, to be conducted in Kwa-Zulu-Natal, South Africa, seeks to fill this gap. Our goals are to determine the most salient influences on enrollment and retention in HIV care (regardless of ART eligibility) that, if addressed, could optimize use of services among newly diagnosed men and women in resource-constrained settings; and to identify collaboratively with key stakeholders promising interventions for further development and testing. The Specific Aims are to (1a) describe the "time to enrollment" cumulative incidence curve, estimate the proportion that enrolls in HIV primary care, and determine the facilitators of and barriers to enrollment and retention in care at multiple levels of influence - social structural (stigma, poverty, gender inequalities), health systems (organization, policies, providers), and individual (mental health, social cognitions, health-related behaviors); (1b) Explore decision-making around disclosure and enrollment/retention in care, and how stigma, poverty, gender inequalities, and health system factors shape these processes, through repeat in-depth interviews with a sub-sample of cohort participants; and (1c) Identify additional critical issues, including need for and use of mental health, reproductive, and other HIV-related ancillary services among newly diagnosed individuals. We will conduct a prospective Cohort Study following 550 newly- diagnosed women and men for eight months with structured assessments at Baseline, 4- and 8-month follow- up, repeat In-Depth Interviews with a subsample of 30, and additional assessment activities to evaluate variables of theoretical interest at the health system and social structural levels, utilizing GPS mapping, an Inventory of Health and Community Services, Media Tracking and Analysis, and structured Counselor Assessments. To advance intervention development, we will review and integrate study findings and discuss promising interventions based on these findings with public officials, non-governmental organization (NGO) members and staff, health care providers, and HIV+ individuals through Interactive Community Feedback sessions; and conduct capacity-building Intervention Development Workshops to enhance agencies' and community members' capacity to rapidly formulate effective, pro-active responses. PUBLIC HEALTH RELEVANCE: To maximize the benefits of expanded HIV testing and optimize the outcomes of ART scale-up with interventions that promote early linkage with primary HIV care and other supportive services, this study aims to determine the most salient influences on enrollment and retention in HIV primary care among newly diagnosed women and men (regardless of ART eligibility) in a context where HIV stigma and poverty are widespread, gender inequality prevails, health services are constrained and policies and programs are in flux, and where HIV care seeking includes the use of both Western and traditional modalities; and to identify collaboratively with community organizations, health care providers, public officials, and HIV+ individuals promising interventions for further development and testing.

描述（由申请人提供）：随着全球努力扩大治疗方案并增加资源有限国家艾滋病毒感染者获得抗逆转录病毒治疗（ART）的机会，了解人们如何与艾滋病毒初级保健联系起来至关重要，因为许多人进入治疗太晚，无法从抗逆转录病毒治疗中受益。现在有很大的势头来促进艾滋病毒检测，作为增加早期护理登记的一种方式，但对一个人得到艾滋病毒阳性诊断后的一段时间的关注相对较少。由于大多数对艾滋病毒阳性个体的研究都是在已经登记参加护理的人群中进行的，因此，关于在新诊断的人群中登记参加艾滋病毒初级保健和更普遍地寻求护理的促进因素和障碍的知识有限。拟议的为期四年的研究将在南非夸祖鲁-纳塔尔省进行，旨在填补这一空白。我们的目标是确定对艾滋病毒护理登记和保留的最显著影响（无论是否符合抗逆转录病毒治疗资格），如果解决这些影响，可以优化资源受限环境中新诊断的男性和女性对服务的使用；并与关键利益相关者合作确定有希望的干预措施，以进一步开发和测试。具体目标是（1a）描述“入组时间”累积发生率曲线，估计入组艾滋病毒初级保健的比例，并确定在多个影响层面(社会结构（耻辱、贫困、性别不平等）、卫生系统（组织、政策、提供者）和个人（心理健康、社会认知、健康相关行为）的入组和保留护理的促进因素和障碍；（1b）通过对队列参与者的子样本进行重复深度访谈，探索围绕医疗信息披露和登记/保留的决策，以及耻辱、贫困、性别不平等和卫生系统因素如何影响这些过程；（1c）确定其他关键问题，包括新诊断个体对心理健康、生殖和其他艾滋病毒相关辅助服务的需求和使用。我们将对550名新诊断的女性和男性进行为期8个月的前瞻性队列研究，在基线进行结构化评估，4个月和8个月的随访，对30个子样本进行重复深度访谈，并进行额外的评估活动，以评估卫生系统和社会结构层面的理论兴趣变量，利用GPS测绘，健康和社区服务清单，媒体跟踪和分析，以及结构化咨询师评估。为了促进干预措施的发展，我们将审查和整合研究结果，并通过互动社区反馈会议，与政府官员、非政府组织（NGO）成员和工作人员、卫生保健提供者和艾滋病毒感染者讨论基于这些研究结果的有希望的干预措施；并举办能力建设干预发展讲习班，以提高机构和社区成员迅速制定有效和积极应对措施的能力。公共卫生相关性：为了最大限度地扩大艾滋病毒检测的效益，并通过促进与初级艾滋病毒护理和其他支持性服务的早期联系的干预措施优化抗逆转录病毒治疗扩大的结果，本研究旨在确定在艾滋病毒耻辱和贫困普遍存在、性别不平等普遍存在的背景下，新诊断的妇女和男子（无论是否符合抗逆转录病毒治疗资格）在艾滋病毒初级保健中登记和保留的最显著影响。卫生服务受到限制，政策和规划不断变化，艾滋病毒治疗寻求包括使用西方和传统模式；并与社区组织、卫生保健提供者、政府官员和艾滋病毒阳性个体合作，确定有希望进一步开发和测试的干预措施。