A Social Network Analysis of HIV Treatment Partners in Botswana

 描述（由申请人提供）：博茨瓦纳有近五分之一的人口感染艾滋病毒，是世界上艾滋病毒流行率最高的国家之一。低成本、可扩展的干预措施对于支持艾滋病毒感染者（PLWH）坚持抗逆转录病毒治疗（ART）并继续接受护理至关重要。其中一种干预措施是使用治疗/坚持治疗的伙伴，这是全世界至少20个国家的艾滋病毒治疗指南所建议的。具体而言，为了支持依从性和减少治疗中断，包括博茨瓦纳在内的几个国家的国家艾滋病毒政策建议医疗保健提供者鼓励开始抗逆转录病毒治疗的患者确定可以提供支持的个人，陪同患者预约，并提供药物提醒。治疗伙伴必须利用患者的社交网络，要求艾滋病病毒携带者在他们的社交圈中选择一个人来提供社会支持。虽然大量的工作表明社会支持在促进依从性方面的关键作用，但对治疗伙伴有效性的研究显示出喜忧参半的结果。因此，需要进行研究，以确定如何更好地利用治疗伙伴的支持，对健康结果产生最佳效果。拟议的研究目标是从社会网络的角度来确定治疗伙伴的最有效的特征，以告知医疗服务提供者如何指导PLWH治疗伙伴的选择。具体目标是：1）对博茨瓦纳艾滋病毒感染者及其治疗伙伴进行社会网络分析，以回顾性比较与病毒学失败显著相关的个体、二元和社会网络水平特征; 2）定性探索与治疗伙伴相关的因素， 选择，包括选择有效治疗伙伴的障碍和促进因素; 3）利用研究结果为医疗保健提供者制定和传播信息，指导艾滋病毒感染者选择适当的治疗伙伴。我们将在博茨瓦纳招募200名有治疗伙伴的艾滋病毒携带者，选择一半显示病毒学失败，一半显示病毒学抑制。我们将对PLWH及其治疗伙伴进行社会网络评估，并收集描述其社交网络的定性数据，以检查与治疗伙伴相关的个体、二元和社会网络因素在组间的差异程度。我们将向博茨瓦纳结核病和艾滋病毒/艾滋病临床护理委员会的成员介绍研究结果，该委员会为博茨瓦纳卫生部艾滋病毒/艾滋病预防和护理司制定了国家艾滋病毒和艾滋病治疗准则。拟议中的研究提供了一个独特的机会，以研究如何改善ART在实践中的使用，这是一个对该领域至关重要的主题。

 DESCRIPTION (provided by applicant): With nearly a fifth of the population living with HIV, Botswana has one of the highest HIV prevalences in the world. Low-cost, scalable interventions are essential to support people living with HIV (PLWH) to adhere to antiretroviral treatment (ART) and remain in care. One such intervention is the use of treatment/adherence partners, which are recommended by HIV treatment guidelines in at least 20 countries world-wide. Specifically, to support adherence and reduce treatment discontinuation, national HIV policies of several countries, including Botswana, recommend that healthcare providers encourage patients initiating ART to identify an individual who can provide support, accompany patients to appointments, and provide reminders for medication. Treatment partners necessarily leverage patients' social networks, requiring that PLWH select an individual in their social circle to provie social support. Although a large body of work indicates the key role of social support in promoting adherence, research on the effectiveness of treatment partners has shown mixed results. Thus, research is needed to determine the ways in which support from treatment partners can be better harnessed for optimal effects on health outcomes. The proposed research objective is to determine the most effective characteristics of treatment partners from a social network perspective, in order to inform healthcare providers on how to guide PLWH on treatment partner selection. The specific aims are: 1) To conduct a social network analysis of people living with HIV and their treatment partners in Botswana in order to compare retrospectively individual-, dyadic-, and social network-level characteristics that are significanty associated with virologic failure; 2) To qualitatively explore factors related to treatment partner selection, including perceived barriers to and facilitators of selection of effective treatment partners; and 3) To use study results to develop and disseminate messages for healthcare providers to guide people living with HIV about selection of appropriate treatment partners. We will recruit 200 PLWH with treatment partners in Botswana, selected such that half show virologic failure and half show virologic suppression. We will conduct social network assessments of PLWH and their treatment partners and gather qualitative data describing their social networks in order to examine the extent to which individual, dyadic, and social network factors related to treatment partners differ between groups. We will present the results to members of the Committee for the Clinical Care of TB and HIV/AIDS in Botswana, which develops the National HIV and AIDS Treatment Guidelines for the Botswana Department of HIV/AIDS Prevention and Care in the Botswana Ministry of Health. The proposed research presents a unique opportunity to examine ways to improve use of ART in practice, a topic of critical importance to the field.