Decreasing Interruptions and Losses from HIV Care in Nigeria

减少尼日利亚艾滋病毒护理造成的中断和损失

• 批准号: 8617800
• 负责人: Aimalohi Ahonkhai
• 金额: $ 18.18万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-13 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8617800
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Adult; African; Aftercare; Behavior; Biometry; Caring; Characteristics; Chronic; Clinic; Community Outreach; Conflict (Psychology); Country; Critical Care; Data; Databases; Development; Ensure; Epidemiology; Evaluation; Fees; Food Supplementation; Frequencies; Goals; HIV; Half-Life; Health Services Accessibility; Health system; Healthcare; Home environment; Hour; Interruption; Intervention; K-Series Research Career Programs; Knowledge; Life; Life Expectancy; Medicine; Mentored Patient-Oriented Research Career Development Award; Methodology; Morbidity - disease rate; Nigeria; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Positioning Attribute; Predictive Factor; Primary Health Care; Process; Program Evaluation; Provider; Public Health; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Services; Severity of illness; Site; South Africa; Statistical Methods; Support Groups; Surveys; Technical Expertise; Time; Training; Translating; Transportation; Uncertainty; Validation; Variant; Waiting Lists; Wellness Program; Work; antiretroviral therapy; base; care seeking; career; cohort; deprivation; design; effective intervention; experience; flexibility; follow-up; implementation research; implementation science; improved; insight; male; mortality; novel; programs; prospective; public health relevance; scale up; sex; skills; social stigma; theories; therapy design; treatment center; treatment program

DESCRIPTION (provided by applicant): With 160 million inhabitants, Nigeria is the most populous African nation, and home to the second largest number of people living with HIV/AIDS in the world (3.5 million). In Nigeria and other resource-limited countries (RLS), loss to follow-u (LTFU) poses a major challenge to the successful provision of chronic HIV care. One in four patients are lost-to-follow-up one year after initiating antiretroviral therapy (ART), resulting in loss of over half of the life expectancy gains provided by ART. While some patients are completely lost from HIV care, a lesser-studied group, approximately one in three, briefly interrupt but return to care. Our previous work in South Africa suggests that unplanned care interruptions portend poor patient outcomes. Many studies have characterized patient-level predictors of LTFU, but this knowledge has not enabled service providers to adequately improve patient retention. In addition, few studies have systematically assessed whether health system-level characteristics, which vary widely across treatment programs, predict LTFU and unplanned care interruption. Missing from the assessment of both patient and health system-level predictors of LTFU is an assessment of how these factors inform patient decisions to remain in HIV care, a concept known as "decisional conflict". My goal in this proposed K23 award is to utilize a novel framework incorporating health system and patient-level predictors of LTFU and unplanned care interruption, with determinants of patient decisional conflict. This will inform development of a pilot intervention to improve patient retention in HIV care in Nigeria. To accomplish this goal, I will study the AIDS Prevention Initiative Nigeria's (APIN) network in 32 comprehensive HIV treatment centers in 9 of Nigeria's 36 states. I will first investigate health system factors predictive of LTFU and unplanned care interruption by surveying clinic directors on a range of health system services available to their patients, and assessing outcomes of 1,500 patients over one year. I will then establish a cohort of 752 ART-eligible adults to determine the relationship of patient risk factors related to decisional conflict (disease severity stigma, resource deprivation and competing needs) about adhering to chronic HIV care, and the association between decisional conflict and both LTFU and unplanned care interruption one year after ART initiation. Finally, I will build on these findings to develop a pilot intervention n HIV-infected, ART-eligible patients based on a home-based HIV care construct to ameliorate decisional conflict by addressing both health system processes and patient obstacles to HIV care. The research proposed in this K23 award will build on my previous training in epidemiology and biostatistics, allow me to receive further training in quality improvement theory and methodology as well as technical expertise in large program evaluation and intervention design, and will ideally position me to launch my career as an investigator in HIV outcomes and implementation science in RLS.

描述（由申请人提供）：尼日利亚拥有1.6亿居民，是人口最多的非洲国家，是世界上艾滋病毒/艾滋病的第二大人数（350万）。在尼日利亚和其他资源有限的国家（RLS）中，损失跟随U（LTFU）对成功提供慢性艾滋病毒护理构成了重大挑战。启动抗逆转录病毒疗法（ART）一年后，四分之一的患者丧失了至伴随的患者，导致 损失了一半以上的预期寿命增长。尽管有些患者完全因艾滋病毒护理而丢失，但较少研究的群体，大约三分之一，短暂中断，但重返护理。我们以前在南非的工作表明，计划外的护理中断预示了差的患者结果。许多研究表征了LTFU的患者级预测指标，但是这些知识并未使服务提供者能够充分改善患者的保留率。此外，很少有研究系统地评估卫生系统级特征在治疗方案中是否差异很大，可以预测LTFU和计划外的护理中断。评估LTFU的患者和卫生系统级预测因素的评估是对这些因素如何为患者决定保留在艾滋病毒护理中的评估，这是一种称为“决策冲突”的概念。我在拟议的K23奖项中的目标是利用一个新的框架，该框架结合了LTFU和计划外护理中断的患者级预测指标，并具有患者决策冲突的决定因素。这将为开发试点干预措施，以改善尼日利亚的艾滋病毒护理患者保留率。为了实现这一目标，我将在尼日利亚36个州的9个州中的32个综合艾滋病毒治疗中心中研究尼日利亚的艾滋病预防倡议（APIN）网络。我将首先通过对患者可用的一系列卫生系统服务进行调查，并评估一年内1,500名患者的结果，从而对LTFU和计划外护理中断的预测卫生系统因素进行了预测。然后，我将建立一个由752名符合ART资格的成年人组成的队列，以确定与决策冲突有关的患者风险因素（疾病严重性的污名，资源剥夺和竞争需求）有关遵守慢性HIV护理的关系，以及在艺术启动后一年的LTFU与LTFU和未计划的护理中断之间的关系之间的关联。最后，我将基于这些发现，以基于家庭基于家庭的艾滋病毒护理结构的艾滋病毒感染，符合艺术性的艾滋病毒资格患者来开发试点干预，通过解决卫生系统过程和患者的艾滋病毒护理障碍，以减轻决策冲突。这项K23奖提出的研究将基于我以前在流行病学和生物统计学方面的培训，使我能够接受质量改进理论和方法论的进一步培训，以及大型计划评估和干预设计方面的技术专业知识，理想情况下，我将成为RLS中HIV OUTCOM和实施科学研究者的职业。