GH12-008: Enhancing linkage to HIV care for newly detected HIV-positive persons in Ukraine

GH12-008：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: 8725055
• 负责人: Oleksandr Neduzhko
• 金额: $ 0.5万
• 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 2018-03-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8725055
• 关键词: GH12; 008; Enhancing; linkage; HIV

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.

项目摘要摘要 每年在乌克兰登记的艾滋病毒新病例超过2万例，约40% 他们同时患有艾滋病。在新诊断为艾滋病毒阳性的人中，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，而且还在不断上升。而专科医生的病人 卫生保健设施(SHCF)(药物滥用、结核病和性传播感染诊所)，在那里，大多数患者 艾滋病毒危险行为被发现，有机会获得免费艾滋病毒检测，仍有迫切需要 改善对艾滋病毒感染者的适当艾滋病毒护理的参与度(联系和保留)。 存在一种加强与艾滋病毒护理联系的模式，并被证明是有效的 美国，但还没有在乌克兰的文化背景下进行测试。这项研究的目标是试行， 实施并评估旨在激励和管理最近感染艾滋病毒的干预措施 乌克兰三个地区确诊的SHCF患者，他们将得到支持和激励 开始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准入研究(MARTAS)干预 关于参与艾滋病毒护理的理论、激励会议和护士病例管理 最近检测到艾滋病毒阳性的患者。 在我们的研究中，我们将使用可用的医疗保健基础设施和人力资源。这 该项目将在乌克兰的奥德萨、第聂伯罗彼得罗夫斯克和米科拉耶夫地区实施，地点为 在存在赞助护士制度的情况下，以及提供者发起的艾滋病毒检测和 咨询(PITC)方法最近已经实施。这项研究的具体目的是： 1)调整ARTAS干预方案，以便在最近诊断的艾滋病毒中实施 乌克兰文化背景下的阳性患者使用形成性评估的结果(在- 与患者的深度访谈和与医疗保健提供者的焦点小组讨论 第聂伯罗彼得罗夫斯克)；2)测试实施干预措施的可行性和可接受性 Mykolaiv地区的三个地点有30名最近诊断为艾滋病毒阳性的患者；以及3)到 应用前瞻性队列研究对3个地区9个地点的干预效果进行评估 (n=300名最近确诊的艾滋病毒患者)比较观察到的 研究参与者在干预前一年的HIV护理登记/保留情况 实施。我们假设，涉及协调的干预行动 专门的保健和艾滋病毒系统，通过a)由一名护士提供的联动协调 B)有组织的激励会议和这些联系之间的进一步沟通 协调人(LC)和患者，以及c)LC和HIV护理提供者之间的沟通将 导致更多人参与艾滋病毒医疗护理。这项拟议的研究解决了一个重要的 非/迟登记艾滋病毒阳性者参加艾滋病毒护理和治疗对公共卫生的威胁 治疗。我们的研究具有很高的创新性，因为我们将扩展Artas的国际边界 针对乌克兰的实施研究，使其适应当地的基础设施。