Community HIV Testing and Linkage to Care in Uganda

乌干达的社区艾滋病毒检测及其与护理的联系

• 批准号: 8733198
• 负责人: Laura M Bogart
• 金额: $ 22.08万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-11 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8733198
• 关键词: AIDS prevention; Africa South of the Sahara; Aftercare; Caring; Client; Clinic; Communicable Diseases; Communities; Counseling; Couples; Diagnosis; Early treatment; Event; Feedback; Fishes; HIV; HIV Seropositivity; Health Services Accessibility; Healthcare; Home environment; Hour; Human immunodeficiency virus test; Incidence; Income; Individual; Infection; Institutes; Interview; Life; Link; Location; Marketing; Methods; Multiple Partners; Newly Diagnosed; Nomads; Patients; Phase; Population; Positive Test Result; Prevalence; Process; Protocols documentation; Qualitative Methods; Reporting; Research; Rural; Rural Community; Sampling; Services; Site; Solutions; Spouses; Structure; Subgroup; Testing; Time; Touch sensation; Transportation; Typology; Uganda; Universities; Vulnerable Populations; Woman; Work; aged; antiretroviral therapy; base; care seeking; evidence base; high risk; innovation; men; novel; programs; public health relevance; rural area; scale up; transmission process

DESCRIPTION (provided by applicant): In Uganda, HIV prevalence is estimated to be over 7% among those aged 15-49 and is rising. Yet, only 21% of Ugandans are aware of their HIV-serostatus. Community HIV testing has increased in Uganda and sub- Saharan Africa recently, and holds promise in efficiently reaching individuals from high-risk rural and migrant communities that are not touched by healthcare-based testing. In Uganda, most community testing is delivered in temporary, mobile venues, and can reach large numbers of people (up to 1,900 per day). Nevertheless, community testing presents considerable challenges for timely linkage to care after diagnosis. In rural settings, people who test positive may be referred to clinics many kilometers away; unpaved roads combined with lack of adequate transportation may deter care- seeking. Referral to care is especially difficult for high-risk migrant populations such as people in trading/market communities (who frequently move to different markets across the region), or fisherfolk (who spend most of the time fishing away from home, and who have multiple landing sites at different lakeshore locations). We propose to systematically explore barriers to and facilitators of linkage to care using iterative mixed (qualitative and quantitative methods, to ultimately develop novel solutions that are feasible for scale-up in diverse community testing venues. The specific aims are: (1) to use qualitative methods to understand the organizational protocol for, barriers to, and facilitators of linkage to care, and potential noel solutions, in three different types of community HIV testing settings (rural villages, trading communities, fishing communities); and (2) to examine quantitatively the barriers to and facilitators of linkage to care among people newly diagnosed with HIV at different community HIV testing settings. In Phase 1, we will conduct 10 qualitative interviews with key stakeholders in community-based organizations that conduct community testing, and observe three diverse testing scenarios in high-risk communities (trading communities, fishing communities, rural villages) to understand the current protocol for testing and referrals to care. We will also conduc qualitative interviews with 30 individuals who receive a positive test result to explore potential barriers to and facilitators of linkage to care. In Phase 2, we will quantitatively and longitudinaly examine barriers to and facilitators of linkage to care, as well as time to receipt of care, among sample of 240 individuals who test positive for HIV (80 per testing site type). In Phase 3, using an iterative process, we will conduct additional qualitative interviews with 5 key stakeholders (from Phase 1) and 18 HIV-positive testing clients (from Phase 2), in order to elicit feedback about the meaning of the Phase 1 and Phase 2 results, and input on innovative solutions for linkage to care following receipt of a positive test result in community HIV testing.

描述（由申请人提供）：在乌干达，15-49 岁人群中艾滋病毒感染率估计超过 7%，并且还在上升。然而，只有 21% 的乌干达人知道自己的 HIV 血清状况。最近，乌干达和撒哈拉以南非洲地区的社区艾滋病毒检测有所增加，有望有效覆盖来自未接受基于医疗保健检测的高风险农村和移民社区的个人。在乌干达，大多数社区检测都是在临时的移动场所进行，可以覆盖大量人群（每天最多 1,900 人）。然而，社区检测对诊断后及时联系护理提出了相当大的挑战。在农村地区，检测呈阳性的人可能会被转诊到几公里之外的诊所；未铺砌的道路加上缺乏足够的交通可能会阻碍就医。对于高风险移民群体来说，转诊尤其困难，例如贸易/市场社区的人们（他们经常迁移到该地区的不同市场）或渔民（他们大部分时间都在外捕鱼，并且在不同的湖岸位置有多个登陆点）。我们建议使用迭代混合（定性和定量方法）系统地探索护理联系的障碍和促进因素，最终开发出可在不同社区检测场所扩大规模的新颖解决方案。具体目标是：（1）使用定性方法来了解三种不同类型的社区 HIV 检测中护理联系的组织协议、障碍和促进因素，以及潜在的 noel 解决方案 环境（乡村、贸易社区、渔业社区）； (2) 定量研究不同社区艾滋病毒检测机构中新诊断艾滋病毒感染者与护理联系的障碍和促进因素。在第一阶段，我们将与进行社区测试的社区组织中的主要利益相关者进行 10 次定性访谈，并观察高风险社区（贸易社区、渔业社区、 农村）了解当前的检测和转诊护理方案。我们还将对 30 名检测结果呈阳性的人进行定性访谈，以探讨与护理联系的潜在障碍和促进因素。在第二阶段，我们将在 240 名 HIV 检测呈阳性的个体（每种检测点类型 80 名）样本中，定量和纵向地检查与护理联系的障碍和促进因素，以及接受护理的时间。 在第 3 阶段，我们将采用迭代流程，对 5 个关键利益相关者（来自第 1 阶段）和 18 个 HIV 阳性检测客户（来自第 2 阶段）进行额外的定性访谈，以征求有关第 1 阶段和第 2 阶段结果含义的反馈，并就在社区 HIV 检测中收到阳性检测结果后与护理联系起来的创新解决方案提出意见。