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: 8541357
• 负责人: Aimalohi Ahonkhai
• 金额: $ 18.52万
• 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/8541357
• 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，是非洲人口最多的国家，也是世界上艾滋病毒/艾滋病感染者人数第二多的国家（350万）。在尼日利亚和其他资源有限的国家，失访对成功提供慢性艾滋病毒护理构成重大挑战。四分之一的患者在开始抗逆转录病毒治疗（ART）一年后失访， 虽然一些患者完全失去了艾滋病毒护理，但研究较少的一组，大约三分之一，短暂中断但返回护理。我们之前在南非的工作表明，计划外的护理中断预示着患者的预后不良。许多研究已经描述了LTFU的患者水平预测因素，但这些知识并没有使服务提供者能够充分改善患者保留。此外，很少有研究系统地评估卫生系统水平的特征，这些特征在治疗方案中差异很大，可以预测LTFU和计划外护理中断。在对患者和卫生系统层面的LTFU预测因素的评估中，缺少对这些因素如何告知患者继续接受艾滋病毒护理的决定的评估，这一概念被称为“决策冲突”。我在这个拟议的K23奖的目标是利用一个新的框架，将卫生系统和患者水平的预测LTFU和计划外的护理中断，与患者决策冲突的决定因素。这将为制定一项试点干预措施提供信息，以改善尼日利亚艾滋病毒护理中的病人保留情况。为了实现这一目标，我将研究尼日利亚艾滋病预防倡议（APIN）在尼日利亚36个州中的9个州的32个艾滋病综合治疗中心的网络。我将首先调查预测LTFU和计划外护理中断的卫生系统因素，调查诊所主任对患者提供的一系列卫生系统服务，并评估一年内1,500名患者的结果。然后，我将建立一个队列的752 ART合格的成年人，以确定患者的风险因素的关系，与决策冲突（疾病严重程度的耻辱，资源剥夺和竞争的需要）坚持慢性艾滋病护理，以及决策冲突之间的关联和长期随访和计划外的护理中断ART启动后一年。最后，我将建立在这些研究结果的基础上，开发一个试点干预艾滋病毒感染，ART资格的患者基于家庭为基础的艾滋病毒护理结构，以改善决策冲突，解决卫生系统的过程和患者的障碍，艾滋病毒护理。在这个K23奖提出的研究将建立在我以前的流行病学和生物统计学的培训，让我接受质量改进理论和方法的进一步培训，以及在大型项目评估和干预设计的技术专业知识，并将理想地定位我启动我的职业生涯作为一个调查员在艾滋病毒的结果和实施科学在RLS。