Linkage & Retention: A Randomized Trial to Optimize HIV/TB Care in South Africa

连锁

基本信息

批准号：
8462802
负责人：
Ingrid Valerie Bassett
金额：
$ 13.69万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-05-01 至 2013-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8462802
关键词：
Address Adherence Affect Africa South of the Sahara African Behavioral Behavioral Sciences Biometry CD4 Lymphocyte Count Caring Cause of Death Cessation of life Collaborations Critical Care Data Death Rate Diagnosis Diagnostic Services Disease Early Diagnosis Effectiveness of Interventions Enrollment Epidemic Failure Funding Gap Junctions Government HIV HIV diagnosis Health system Healthcare High Prevalence Human immunodeficiency virus test Immunologics Improve Access Individual Intervention Lead Life Link Medical Mentored Patient-Oriented Research Career Development Award Modeling Newly Diagnosed Outcome Outcome Assessment Outpatients Patients Physicians Policy Maker Positioning Attribute Province Quality of Care Randomized Controlled Trials Research Research Infrastructure Research Personnel Resources Risk Behaviors Screening procedure South Africa Target Populations Testing Time Tuberculosis United States National Institutes of Health Work antiretroviral therapy attributable mortality base clinical epidemiology cost cost effective cost effectiveness follow-up health care service utilization improved mortality novel pandemic disease programs public health relevance randomized trial response social standard of care treatment program tuberculosis treatment

项目摘要

DESCRIPTION (provided by applicant): The benefits of antiretroviral therapy (ART) can only be achieved through timely HIV diagnosis, successful linkage to care, and treatment initiation. In South Africa, however, only a fraction of those newly diagnosed with HIV enter HIV care. The period after HIV testing but prior to ART initiation represents a time of very high mortality, fueled by the tuberculosis (TB) epidemic, and therefore a time when improving access to TB screening and HIV care would be of substantial benefit. Though TB is the leading cause death among those with HIV in sub-Saharan Africa, less than one-third of HIV-infected South Africans have been screened for TB. Efforts are urgently needed to implement and evaluate strategies that improve early diagnosis and linkage to HIV and TB care, and to consider such strategies in the context of constrained healthcare resources. We propose two specific aims. The first aim is to conduct a randomized controlled trial to establish the efficacy of a health system navigator intervention in improving linkage to HIV and TB care among newly diagnosed HIV-infected outpatients in Durban, South Africa. Using Andersen's model of health service utilization as a theoretical framework, we will provide a health system navigator to help patients identify and overcome barriers to care and we will examine the intersection of contextual and patient-level factors that affect linkage to care. The second aim is to evaluate the cost and cost-effectiveness of this intervention for promoting linkage to HIV and TB care at the time of HIV screening. The 2010 Trans-NIH Plan for HIV-related research prioritizes the assessment of outcomes related to TB and HIV care integration on survival, quality of care, and cost, as well as the impact of different approaches for testing, linkage, and retention in care in improving outcomes of HIV disease. The proposed study will address several of these important issues through collaboration among medical, behavioral and cost- effectiveness experts working in the US and the South African province with the highest prevalence of HIV and TB. The results will inform HIV and TB care in South Africa and in other resource-limited settings. PUBLIC HEALTH RELEVANCE: The period after a new HIV diagnosis, but prior to starting antiretroviral therapy, is a time of very high mortality for patients in South Africa, and therefore a time when improving access to HIV care would be of substantial benefit. We propose to study the impact and cost-effectiveness of an intervention to improve linkage to HIV and TB care for newly diagnosed HIV-infected people in Durban, South Africa.

描述（由申请人提供）：抗逆转录病毒疗法（ART）的益处只能通过及时的HIV诊断，成功与护理的联系以及治疗开始。但是，在南非，只有一小部分被诊断出患有艾滋病毒的人进入艾滋病毒护理。艾滋病毒测试后但在ART启动之前的时期代表了结核病（TB）流行的助长时期，因此，改善获得结核病筛查和HIV护理的时期将带来重大的好处。尽管结核病是撒哈拉以南非洲艾滋病毒的主要原因死亡，但已将不到三分之一的艾滋病毒感染的南非人筛选为结核病。迫切需要努力来实施和评估策略，以改善早期诊断和与艾滋病毒和结核病护理的联系，并在医疗保健资源受限的背景下考虑此类策略。我们提出了两个具体目标。第一个目的是进行一项随机对照试验，以确定卫生系统导航器干预措施在南非新诊断的新诊断的HIV感染的门诊病人之间改善与HIV和TB护理联系的功效。我们将使用安德森的卫生服务利用模型作为理论框架，我们将提供一个卫生系统导航器，以帮助患者识别和克服护理的障碍，我们将研究影响与护理联系联系的上下文和患者级别因素的相交。第二个目的是评估这种干预措施在艾滋病毒筛查时促进与艾滋病毒和结核病护理联系的成本和成本效益。 2010年与HIV相关研究的Trans-NIH计划优先考虑与结核病和艾滋病毒护理一体化有关生存，护理质量和成本相关的结果的评估，以及不同方法在改善艾滋病毒疾病结果方面的测试，联系和保留的不同方法的影响。拟议的研究将通过在美国和南非省的艾滋病毒和结核病患病率最高的医疗，行为和成本效益专家之间的合作解决这些重要问题。结果将为南非以及其他资源有限的环境中的艾滋病毒和结核病护理提供信息。公共卫生相关性：新的艾滋病毒诊断后的时期，但在开始抗逆转录病毒疗法之前，是南非患者死亡率很高的时期，因此，改善艾滋病毒护理的机会将带来可观的好处。我们建议研究一种干预措施的影响和成本效益，以改善南非德班新诊断的艾滋病毒感染者与艾滋病毒和结核病护理的联系。