Implementing Point of Care CD4 Analysis to Decentralize HIV Care in Rural Africa

实施床旁 CD4 分析以分散非洲农村地区的艾滋病毒护理

基本信息

  • 批准号:
    8410263
  • 负责人:
  • 金额:
    $ 20.9万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2012
  • 资助国家:
    美国
  • 起止时间:
    2012-08-01 至 2014-07-31
  • 项目状态:
    已结题

项目摘要

DESCRIPTION (provided by applicant): More than 5.6 million people are estimated to be living with HIV in South Africa, the largest epidemic in the world. A substantial proportion (45%) of these are believed to be eligible for initiation of antiretroviral therapy (ART), but despite a major government effort, many are not aware of their HIV status and only 55% of eligible patients are receiving life saving treatment. Community-based voluntary counseling and testing for HIV is a new strategy for improving HIV testing rates, diagnosing patients earlier in the course of disease with the potential to link patients to care and treatment with ART and to reduce HIV morbidity and mortality. A major obstacle to ART initiation among newly diagnosed HIV patients in sub-Saharan Africa is CD4 cell count staging to determine eligibility for treatment. In South Africa, CD4 cell testing is performed in centralized laboratories, requiring sophisticated and expensive laboratory infrastructure and currently, senior level nurses to draw blood. Hard to reach individuals living in impoverished rural areas have limited access to both CD4 cell testing facilities and to the professional nurses required to obtain the blood for analysis. Rapid CD4 cell point of care (POC) diagnostics has the potential to substantially reduce delays associated with CD4 count staging and to facilitate linkage to care. The PIMA diagnostic analyzer can provide an accurate CD4 cell count in 20 minutes and can utilize finger stick obtained samples. In addition, PIMA is portable, simple and relatively inexpensive. POC CD4 testing in a community setting can ensure CD4 results are available immediately after HIV diagnosis. Furthermore, the use of capillary blood for PIMA analysis would allow for task shifting from professional nurses to HIV counselors thereby reducing costs, promoting decentralization of HIV services and freeing nurses to initiate ART and other critical and more expert services. We propose to perform an operational research study of the implementation of the PIMA POC test nested into an existing successful integrated HIV/TB community based case finding platform in an impoverished rural South African region with extremely high HIV prevalence and mortality. Mobile teams which currently perform HIV testing at community congregate settings will be utilized. The implementation measures to be studied include 1) comparison of flow cytometry on venous blood to PIMA analysis of fingerstick capillary blood 2) comparison of nurses and HIV counselors performing PIMA fingerstick capillary blood testing and 3) feasibility and acceptance of the PIMA fingerstick testing in a remote rural area and 4) estimation of the time saved to ART initiation with use of PIMA. The study will be performed by a US and South African team that has successfully collaborated on HIV studies for a decade. It has the potential for providing the evidence to support task shifting of scarce human resources, increase HIV case finding, access to care, and ART provision in an underserved rural area. This project will inform public health policy and practice in high HIV prevalence resource limited settings globally. PUBLIC HEALTH RELEVANCE: PAR-10-040 Rapid point of care CD4 diagnostics can reduce the delays associated with CD4 staging for antiretroviral therapy initiation among newly diagnosed HIV patients in sub-Saharan Africa. This proposal will demonstrate that use of fingerstick obtained capillary blood for rapid point of care CD4 testing by a new technology can be performed by HIV counselors instead of highly trained nurses and can facilitate task shifting and decentralization of HIV services. This project has the potential to inform public health policy and practice in high HIV prevalence resource limited settings and to expand antiretroviral access and treatment in sub Saharan Africa and globally.
描述(由申请人提供):南非估计有超过 560 万人感染艾滋病毒,这是世界上最严重的艾滋病毒流行国。其中很大一部分(45%)被认为有资格开始抗逆转录病毒治疗(ART),但尽管政府做出了重大努力,但许多人并不知道自己的艾滋病毒状况,而且只有 55% 的合格患者正在接受挽救生命的治疗。基于社区的艾滋病毒自愿咨询和检测是提高艾滋病毒检测率、在病程早期诊断患者的新策略,有可能将患者与抗逆转录病毒治疗联系起来,并降低艾滋病毒发病率和死亡率。撒哈拉以南非洲地区新诊断的 HIV 患者启动 ART 的一个主要障碍是 CD4 细胞计数分期,以确定治疗资格。在南非,CD4 细胞检测是在集中实验室进行的,需要复杂且昂贵的实验室基础设施,目前还需要高级护士来抽血。生活在贫困农村地区的人们很难接触到 CD4 细胞检测设施,也无法获得获取血液进行分析所需的专业护士。 快速 CD4 细胞护理点 (POC) 诊断有可能大幅减少与 CD4 计数分期相关的延迟,并促进与护理的联系。 PIMA 诊断分析仪可在 20 分钟内提供准确的 CD4 细胞计数,并可利用指尖采集的样本。此外,PIMA 便于携带、简单且相对便宜。在社区环境中进行 POC CD4 检测可以确保在 HIV 诊断后立即获得 CD4 结果。此外,使用毛细血管血进行 PIMA 分析将使任务从专业护士转移到艾滋病毒咨询师,从而降低成本,促进艾滋病毒服务的分散,并使护士能够启动抗逆转录病毒治疗和其他关键的、更专业的服务。 我们建议对 PIMA POC 测试的实施情况进行一项业务研究,该测试嵌入到艾滋病毒感染率和死亡率极高的南非贫困农村地区现有的成功的综合艾滋病毒/结核病社区病例发现平台中。将利用目前在社区聚集场所进行艾滋病毒检测的流动小组。要研究的实施措施包括 1) 静脉血流式细胞术与指尖采血毛细血管血 PIMA 分析的比较 2) 护士和 HIV 咨询师进行 PIMA 指尖毛细血管血检测的比较 3) PIMA 指尖采血检测在偏远农村地区的可行性和接受度 4) 估计使用 PIMA 启动 ART 所节省的时间。 这项研究将由美国和南非的团队进行,该团队在艾滋病毒研究方面已成功合作十年。它有可能提供证据来支持稀缺人力资源的任务转移、增加艾滋病毒病例发现、获得护理的机会以及在服务不足的农村地区提供抗逆转录病毒治疗。该项目将为全球艾滋病毒高流行资源有限地区的公共卫生政策和实践提供信息。 公共卫生相关性:PAR-10-040 快速护理点 CD4 诊断可以减少撒哈拉以南非洲地区新诊断的 HIV 患者开始抗逆转录病毒治疗时与 CD4 分期相关的延迟。该提案将证明,通过新技术使用指尖采血获得的毛细血管血进行快速护理点 CD4 检测可以由艾滋病毒顾问而不是训练有素的护士进行,并且可以促进艾滋病毒服务的任务转移和分散。该项目有可能为公共卫生政策提供信息 在艾滋病毒高流行率资源有限的环境中开展工作和实践,并扩大撒哈拉以南非洲和全球的抗逆转录病毒治疗的可及性和治疗范围。

项目成果

期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)

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Gerald H. Friedland其他文献

Mediastinitis after cardiovascular surgery.
心血管手术后纵隔炎。
  • DOI:
  • 发表时间:
    1983
  • 期刊:
  • 影响因子:
    0
  • 作者:
    D. Bor;R. Rose;J. Modlin;R. Weintraub;Gerald H. Friedland
  • 通讯作者:
    Gerald H. Friedland

Gerald H. Friedland的其他文献

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{{ truncateString('Gerald H. Friedland', 18)}}的其他基金

Implementing Point of Care CD4 Analysis to Decentralize HIV Care in Rural Africa
实施床旁 CD4 分析以分散非洲农村地区的艾滋病毒护理
  • 批准号:
    8512657
  • 财政年份:
    2012
  • 资助金额:
    $ 20.9万
  • 项目类别:
Drug Interactions in Substance Abusers with HIV Infection
艾滋病毒感染者的药物相互作用
  • 批准号:
    8102010
  • 财政年份:
    2008
  • 资助金额:
    $ 20.9万
  • 项目类别:
Drug Interactions in Substance Abusers with HIV Infection
艾滋病毒感染者的药物相互作用
  • 批准号:
    7579155
  • 财政年份:
    2008
  • 资助金额:
    $ 20.9万
  • 项目类别:
Drug Interactions in Substance Abusers with HIV Infection
艾滋病毒感染者的药物相互作用
  • 批准号:
    7678377
  • 财政年份:
    2008
  • 资助金额:
    $ 20.9万
  • 项目类别:
Drug Interactions in Substance Abusers with HIV Infection
艾滋病毒感染者的药物相互作用
  • 批准号:
    7884371
  • 财政年份:
    2008
  • 资助金额:
    $ 20.9万
  • 项目类别:
Drug Interactions in Substance Abusers with HIV Infection
艾滋病毒感染者的药物相互作用
  • 批准号:
    8284483
  • 财政年份:
    2008
  • 资助金额:
    $ 20.9万
  • 项目类别:
NEW ENGLAND PROGRAM FOR AIDS CLINICAL TRIALS-PROACT (CPC
新英格兰艾滋病临床试验计划 - PROACT (CPC
  • 批准号:
    6632053
  • 财政年份:
    2000
  • 资助金额:
    $ 20.9万
  • 项目类别:
NEW ENGLAND PROGRAM FOR AIDS CLINICAL TRIALS-PROACT (CPC
新英格兰艾滋病临床试验计划 - PROACT (CPC
  • 批准号:
    6746887
  • 财政年份:
    2000
  • 资助金额:
    $ 20.9万
  • 项目类别:
NEW ENGLAND PROGRAM FOR AIDS CLINICAL TRIALS-PROACT (CPC
新英格兰艾滋病临床试验计划 - PROACT (CPC
  • 批准号:
    7194941
  • 财政年份:
    2000
  • 资助金额:
    $ 20.9万
  • 项目类别:
NEW ENGLAND PROGRAM FOR AIDS CLINICAL TRIALS-PROACT (CPC
新英格兰艾滋病临床试验计划 - PROACT (CPC
  • 批准号:
    7068333
  • 财政年份:
    2000
  • 资助金额:
    $ 20.9万
  • 项目类别:

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ESE:合作研究:撒哈拉以南非洲的气候变化和变异性以及武装冲突
  • 批准号:
    0964515
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Network Dynamics, Sexual Behaviour, and HIV Among University Students in Africa South of the Sahara
撒哈拉以南非洲大学生的网络动态、性行为和艾滋病毒
  • 批准号:
    178094
  • 财政年份:
    2008
  • 资助金额:
    $ 20.9万
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    Studentship Programs
Synopsis of Ichneumoniae of Africa, South of the Sahara
撒哈拉以南非洲的姬蜂病简介
  • 批准号:
    66B2956
  • 财政年份:
    1966
  • 资助金额:
    $ 20.9万
  • 项目类别:
To Attend Synopsis of Ichneumoninae of Africa, South of the Sahara
参加撒哈拉以南非洲的姬蜂亚科概要
  • 批准号:
    65B2956
  • 财政年份:
    1965
  • 资助金额:
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  • 项目类别:
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