Peer health workers: Impact on retention, care and secondary prevention of PLHIV

描述（由申请人提供）：我的职业目标是在资源有限的情况下，成为多学科艾滋病毒/艾滋病研究的全球领导者，重点研究艾滋病毒临床护理和二级艾滋病毒预防策略。我的短期目标是成为一名独立的研究者，成为约翰霍普金斯大学终身教职的初级教员，并在乌干达开展一个富有成效和可持续的研究项目。研究项目。我提议的研究包括两个阶段：第一阶段：对乌干达拉凯进行的一项试验的数据集进行二次行为结果分析，该试验旨在评估同伴卫生工作者对艾滋病护理结果的影响。同时，我将对这种同伴卫生工作者干预进行成本效益分析。第2阶段：进行全面的形成性研究，然后实施基于社区的同伴卫生工作者干预试验，以综合(i)提高病人留用率，（ii）提高基本护理包的利用率，以及（iii）减少尚未接受抗逆转录病毒治疗的艾滋病毒感染者的危险性行为。同伴保健工作者的干预将以对个别病人的家访为中心。随后，我将对该干预措施进行成本效益分析。职业发展计划。我提议的培训和指导活动将集中在(i)行为干预研究和（ii） HIV预防和护理干预的成本效益分析研究。我提议的应用研究将与我的培训活动密切协调，重点关注同伴卫生工作者（一群艾滋病毒感染者的社区卫生工作者）对乌干达拉凯的综合病人保留、护理和艾滋病毒二级预防工作的影响。研究环境。我将在约翰霍普金斯大学资金雄厚、受人尊敬的传染病部门得到很好的支持。我还将拥有乌干达Rakai健康科学项目优秀且经过验证的研究基础设施，以支持我的研究计划的设计和实施。

DESCRIPTION (provided by applicant): My career goal is to become a global leader in multidisciplinary HIV/AIDS research in resource- limited settings with a focus on research integrating HIV clinical care and secondary HIV prevention strategies. My short term goal is to establish myself as an independent investigator as a tenure-track junior faculty member at Johns Hopkins and to develop a productive and sustainable program of research in Uganda. Research Project. My proposed research consists of two phases: Phase 1-Perform secondary behavioral outcomes analyses on a dataset of a trial conducted to assess the effect of peer health workers on AIDS care outcomes in Rakai, Uganda. Concurrently, I will perform cost-effectiveness analysis of this peer health worker intervention. Phase 2- Perform comprehensive formative research and then implement a community-based trial of a peer health worker intervention to integratively (i) improve patient retention, (ii) increase basic care package utilization, and (iii) decrease risky sexual behaviors among PLHIV not yet on antiretroviral therapy. The peer health worker intervention will center on home visits to individual patients. Subsequently, I will perform cost-effectiveness analysis of this intervention. Career Development Plan. My proposed training and mentoring activities will center on (i) behavioral intervention research and ii) cost-effectiveness analysis research of HIV prevention and care interventions. My proposed applied research, which will be closely coordinated with my training activities, will focus on the impact of peer health workers, a group of community health workers who are people living with HIV, on integrated patient retention, care, and secondary HIV prevention efforts in Rakai, Uganda. Research Environment. I will be well supported within the well funded and respected Division of Infectious Diseases at Johns Hopkins. I will also have the excellent and proven research infrastructure of the Rakai Health Sciences Program in Uganda to support the design and implementation of my research plan. PUBLIC HEALTH RELEVANCE: These study findings may serve as a model for the design of large scale peer health worker-led interventions to improve the care, retention, and secondary HIV prevention of people living with HIV in low-resource settings. These studies may serve as a model for integrating prevention and care interventions, an area in which there is a critical need for innovative, inexpensive, and effective interventions.