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

随着全球努力扩大治疗方案和增加获得抗逆转录病毒疗法的机会， 在资源有限的国家，了解人们如何与艾滋病毒感染者建立联系至关重要。 护理，因为许多人进入护理太晚，无法从ART中受益。 艾滋病病毒检测作为一种增加早期登记的护理方式，但对处理期的关注相对较少 一个人接受艾滋病毒+诊断后立即。正如大多数对艾滋病毒阳性个体的研究一样， 在那些已经登记参加护理的人中进行，对促进者的了解有限， 新诊断的艾滋病毒感染者在接受初级保健和寻求护理方面遇到障碍。 拟在南非夸祖鲁-纳塔尔进行的四年期研究旨在填补这一空白。我们 目标是确定对HIV护理的登记和保留的最显著影响（无论ART 资格），如果得到解决，可以优化新诊断的男性和女性在 资源有限的环境;与关键利益攸关方合作，确定有希望的干预措施， 进一步的开发和测试。具体目的是（1a）描述"入组时间"累积 发病率曲线，估计在艾滋病毒初级保健登记的比例，并确定促进和 在多个影响层面上，入学和继续接受护理的障碍-社会结构性障碍（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）;（1b）探索围绕披露和登记/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， 通过对队列参与者的子样本进行重复深入访谈;以及（1c）确定其他关键 问题，包括对心理健康、生殖和其他艾滋病毒相关辅助服务的需求和使用 新诊断的人。我们将进行一项前瞻性队列研究，随访550名新- 在基线、4个月和8个月随访时进行结构化评估， 向上，重复深入访谈，子样本为30人，并进行额外的评估活动，以评估 在卫生系统和社会结构层面的理论上感兴趣的变量，利用全球定位系统绘图， 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。为了推进干预发展，我们将审查和整合研究结果，并讨论 根据这些调查结果，与政府官员、非政府组织 成员和工作人员，卫生保健提供者和艾滋病毒阳性个人通过互动社区反馈 并举办能力建设干预发展讲习班，以加强各机构的能力， 社区成员迅速制定有效、积极应对措施的能力。 1

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. 1