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

描述（由申请人提供）：艾滋病毒感染者早期开始抗逆转录病毒治疗（ART）具有巨大的益处，包括降低发病率和死亡率，减少二次传播。在南非，ART项目早期的高死亡率通常是由于护理开始时的晚期疾病。自2010年以来，南非政府一直优先开展广泛的艾滋病毒检测，但除非艾滋病毒感染者及时接受护理，否则这一运动不会改善临床和预防结果。 在撒哈拉以南非洲，青春期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，参与护理方面的挑战，如感觉到的耻辱感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%，在青少年中可能更大。 为了改善青年妇女艾滋病毒检测和治疗之间的联系，必须了解可能妨碍获得临床服务的可改变的障碍。心理社会和行为因素影响艾滋病毒感染者坚持护理和治疗，对青少年可能特别重要，因为他们的心理，社会和身体环境正在发生变化。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。Kirschstein-NRSA个人研究金（F30）的目的是评估南非农村感染艾滋病毒的青少年妇女参与护理的可改变的心理社会障碍。 该研究将是一项为期一年的前瞻性队列研究，在新诊断的艾滋病毒感染的年轻女性中纳入一项正在进行的随机对照试验，具体目的如下：1）评估艾滋病毒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症和焦虑症与参与护理之间的关系;（3）确定对新诊断的艾滋病毒的应对反应与参与护理之间的关系。这项研究将是第一个评估可能影响撒哈拉以南非洲感染艾滋病毒的少女利用保健服务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，以改善对这一弱势和高风险人群的护理参与。 该F30奖学金将为申请人提供以下方面的特殊综合培训： 流行病学，艾滋病毒，传染病和心理健康，以进一步她的职业目标作为一个医生流行病学家研究艾滋病毒感染和性传播疾病在资源稀缺的环境。

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.