Enhancing linkage to HIV care for newly detected HIV-positive persons in Ukraine

加强乌克兰新发现的艾滋病毒阳性者与艾滋病毒护理的联系

• 批准号: 8459619
• 负责人: Oleksandr Neduzhko
• 金额: $ 24.69万
• 依托单位: UKRAINIAN INSTITUTE ON PUBLIC HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8459619
• 关键词: Enhancing; linkage; HIV; care; newly

Project Summary Abstract Each year, more than 20,000 new HIV cases are registered in Ukraine, about 40% of them simultaneously with AIDS. Of the newly diagnosed HIV-positive individuals, only about 60% enroll in HIV care in the same calendar year. As a result, in the antiretroviral era, AIDS morbidity and mortality in Ukraine remain high and keep rising. While patients of specialized health care facilities (SHCFs) (substance abuse, TB, and STI clinics), where most patients with HIV risky behaviors are seen, have access to free HIV testing, there remains a critical need to improve engagement (linkage and retention) in appropriate HIV care for HIV-infected persons. A model of enhancing linkage to HIV care exists and proved to be effective over the U.S., but has not been tested in Ukrainian cultural context. The goal of this study is to pilot, implement and evaluate an intervention designed to motivate and manage recently HIV diagnosed patients of SHCFs in three regions of Ukraine, who will be supported and motivated to initiate and remain in HIV medical care. We will study the impact of the Modified Antiretroviral Treatment Access Study (MARTAS) intervention, based on the Social Cognitive Theory, motivational sessions and nurse case management, on the engagement in HIV care of recently detected HIV-positive patients. In our study we will use available health care infrastructure and human resources. This project will be implemented in Odesa, Dnipropetrovsk and Mykolaiv regions of Ukraine, at the SHCFs, where the system of patronage nurses exists, and provider-initiated HIV testing and counseling (PITC) approach has been implemented recently. The specific aims of the study are: 1) to adapt the ARTAS intervention protocol for implementation among recently diagnosed HIV positive patients in a Ukrainian cultural context using the results of formative assessment (in- depth interviews with patients and focus-group discussion with health care providers in Dnipropetrovsk); 2) to test the feasibility and acceptability of the intervention implementation at three sites of Mykolaiv region with 30 recently diagnosed HIV-positive patients; and 3) to evaluate the intervention effectiveness using prospective cohort study at 9 sites in three regions (n=300 recently HIV diagnosed patients) comparing the observed indicators of enrollment/retention in HIV care among study participants with the year prior to intervention implementation. We hypothesize that an intervention that involves coordination between specialized health care and HIV systems via a) linkage coordination delivered by a nurse of the SHCF, b) structured motivational sessions and further communication between these linkage coordinators (LCs) and patients, and c) communication between LC and HIV care provider will lead to increased engagement in HIV medical care. The proposed research addresses a significant public health threat of non-/late enrollment of HIV-positive individuals in HIV care and treatment. Our study is highly innovative, as we will extend the international borders of ARTAS implementation research to Ukraine, adapting it to the local infrastructure.

项目概要 摘要 乌克兰每年登记的艾滋病毒新病例超过 20,000 例，约占其中的 40% 他们与艾滋病同时发生。在新诊断出的艾滋病毒阳性者中，只有大约 60% 的人在同一日历年参加艾滋病毒护理。因此，在抗逆转录病毒时代，艾滋病 乌克兰的发病率和死亡率仍然很高，并且还在不断上升。虽然专科患者 医疗机构 (SHCF)（药物滥用、结核病和性传播感染诊所），大多数患者都在那里 艾滋病毒危险行为已被发现，能够获得免费艾滋病毒检测，仍然迫切需要 提高艾滋病毒感染者对适当艾滋病毒护理的参与（联系和保留）。 存在一种加强与艾滋病毒护理联系的模式，并被证明在过去一段时间里是有效的 美国，但尚未在乌克兰文化背景下进行测试。这项研究的目标是试点， 实施和评估旨在激励和管理近期艾滋病毒的干预措施 乌克兰三个地区确诊的SHCF患者将得到支持和激励 启动并继续接受艾滋病毒医疗护理。我们将研究修改后的影响 基于社会认知的抗逆转录病毒治疗可及性研究（MARTAS）干预 关于参与艾滋病毒护理的理论、激励课程和护士案例管理 最近发现艾滋病毒阳性患者。 在我们的研究中，我们将利用现有的医疗保健基础设施和人力资源。这 项目将在乌克兰敖德萨、第聂伯罗彼得罗夫斯克和尼古拉耶夫地区实施， SHCF，其中存在赞助护士系统，以及提供者发起的艾滋病毒检测和 最近实施了咨询（PITC）方法。该研究的具体目标是： 1) 调整 ARTAS 干预方案以在最近诊断出的艾滋病毒患者中实施 使用形成性评估结果（in- 与患者进行深度访谈并与医疗保健提供者进行焦点小组讨论 第聂伯罗彼得罗夫斯克）； 2）测试干预措施实施的可行性和可接受性 尼古拉耶夫地区的三个地点有 30 名新近诊断出的艾滋病毒阳性患者； 3) 至 使用前瞻性队列研究评估三个地区 9 个地点的干预效果 （n = 300 名最近诊断出艾滋病毒的患者）比较观察到的指标 研究参与者在干预前一年的艾滋病毒护理登记/保留情况 执行。我们假设干预措施涉及协调 专门的卫生保健和艾滋病毒系统，通过 a) 由护士提供的联系协调 SHCF，b）结构化激励会议以及这些联系之间的进一步沟通 协调员 (LC) 和患者，以及 c) LC 和 HIV 护理提供者之间的沟通将 导致更多地参与艾滋病毒医疗保健。拟议的研究解决了一个重要问题 艾滋病毒阳性者未/延迟参加艾滋病毒护理所造成的公共卫生威胁 治疗。我们的研究具有高度创新性，因为我们将扩展 ARTAS 的国际边界 对乌克兰进行实施研究，使其适应当地基础设施。