Psychosocial Barriers to Engagement in Care in Young South African Women with HIV

描述（由申请人提供）：对艾滋病毒感染者尽早开始抗逆转录病毒治疗有巨大的好处，包括降低发病率和死亡率，减少二次传播。在南非，抗逆转录病毒治疗项目早期出现的高死亡率往往是由于开始治疗时疾病已进入晚期。自2010年以来，南非政府一直优先考虑广泛开展艾滋病毒检测，但除非艾滋病毒感染者及时接受护理，否则这项运动不会改善临床和预防结果。在撒哈拉以南非洲，青少年妇女的艾滋病毒感染率极高。在这一人群中治疗和预防艾滋病毒对于减轻疾病负担至关重要。然而，在感染艾滋病毒的青少年中，参与护理的挑战，如感知到的耻辱和不坚持护理和治疗，可能会被放大。在南非的成年人中，抗逆转录病毒治疗前的护理损失高达50%，在青少年中可能更高。为了改善年轻妇女艾滋病毒检测和治疗之间的联系，必须了解可能妨碍她们获得临床服务的可改变的障碍。社会心理和行为因素影响艾滋病毒感染者对护理和治疗的依从性，对青少年尤其重要，因为他们的心理、社会和身体状况正在发生变化。感染艾滋病毒的青少年患精神健康疾病和行为障碍的风险增加，但这些因素尚未在参与护理的背景下进行研究。这个Kirschstein-NRSA个人奖学金（F30）的目标是评估南非农村感染艾滋病毒的青春期妇女参与护理的可改变的社会心理障碍。该研究将是一项为期一年的前瞻性队列设计，将新诊断为HIV感染的年轻女性纳入一项正在进行的随机对照试验，其具体目的如下：1)评估HIV感染状况的披露与诊断后1年内参与护理之间的关系；2)确定基线和事件抑郁、焦虑障碍与护理参与的关系；3)确定新诊断HIV的应对反应与参与护理的关系。这项研究将首次评估可能影响撒哈拉以南非洲感染艾滋病毒的青春期妇女保健利用的可改变的个人因素。拟议研究的结果将为未来的干预措施提供信息，以提高对这一脆弱和高风险人群的护理参与度。F30奖学金将为申请人提供特殊的综合培训

DESCRIPTION (provided by applicant): Early initiation of anti-retroviral treatment (ART) for HIV-infected persons has enormous benefits, including decreased morbidity and mortality, and reduced secondary transmission. In South Africa, the high mortality rates seen early in ART programs are often due to advanced disease stage at care initiation. The South African government has prioritized widespread HIV testing since 2010 but this campaign will not improve clinical and preventive outcomes unless HIV-infected persons engage in care in a timely manner. In sub-Saharan Africa, the prevalence of HIV infection is extremely high in adolescent women. Treatment and prevention of HIV in this population is critical to reduce the burden of disease. However, challenges to engagement in care, such as perceived stigma and non-adherence to care and treatment, are likely magnified in HIV-infected adolescents. In adults in South Africa, pre-ART loss to care is as high as 50%, and may be even greater in adolescents. To improve the link between HIV testing and treatment among young women, modifiable barriers that might preclude accessing of clinical services must be understood. Psychosocial and behavioral factors affect adherence to care and treatment among HIV-infected persons, and may be especially important for adolescents because their psychological, social, and physical contexts are undergoing change. HIV-infected adolescents are at increased risk of mental health illnesses and behavioral disorders, but these factors have not been studied in the context of engagement in care. The objective of this Kirschstein-NRSA individual fellowship (F30) is to assess modifiable psychosocial barriers to engagement in care among HIV- infected adolescent women in rural South Africa. The proposed study will be a one-year prospective cohort design among newly diagnosed HIV-infected young women incorporated into an ongoing randomized controlled trial, with the following specific aims: 1) To evaluate the relationship between disclosure of HIV infection status and engagement in care over 1 year following diagnosis; 2) To determine the relationship between baseline and incident depression and anxiety disorders and engagement in care; and 3) To determine the relationship between coping responses to newly diagnosed HIV and engagement in care. This study will be the first to evaluate modifiable personal factors that may affect health-care utilization among HIV-infected adolescent women in sub-Saharan Africa. Findings from the proposed research will inform future interventions to improve engagement in care specific to this vulnerable and high-risk population. This F30 fellowship will provide the applicant with exceptional integrated training in epidemiology, HIV, infectious diseases, and mental health to further her career goals as a physician-epidemiologist studying HIV infection and sexually transmitted diseases in resource-scarce settings.