Patterns and Factors Influencing Return to Care among HIV Patients in Zambia

项目摘要/摘要 背景：患者脱离艾滋病毒护理和治疗计划是治疗的主要障碍 撒哈拉以南非洲的优化。虽然初步研究表明，患者重新参与护理是可能的， 人们对重新参与的模式、相关因素以及它们如何导致重返护理知之甚少。 研究目的：本研究的目的是了解再就业的模式、预测因素和机制。 赞比亚成年艾滋病毒患者参与艾滋病毒护理，以便为支持回国的干预措施提供信息 以及随后的留存。 具体目标：i.在赞比亚有代表性的纵向队列脱离患者中，确定时间 回报和个人(例如人口统计)、关系(例如披露)、家庭(例如财富)和设施级别 (例如，人员配备)预测重返艾滋病毒护理的因素，比较重新从事艾滋病毒护理的脱离患者 对于那些在被追踪后没有重新接触的人。二、开发一种精炼的概念模型 患者重新参与指导患者重新参与支持干预。 方法：顺序、混合方法研究建立在申请者重要的过去生活和生活经验基础上 为赞比亚的研究做出贡献。它利用了正在进行的家长研究的数据和基础设施， 申请人是一名协查人员。家长研究正在跟踪随机抽样的5000名失踪的成年艾滋病毒患者 来自赞比亚4个省的31家医疗机构，以确定他们的结果：死亡，参与护理 在别处或者从照顾中解脱出来。目标1将是对约1,000名无工作人员的次要数据分析 来自父母研究的患者，其中估计25%(n=250)将在15个月以上重新参与护理。 生存分析将被用来估计回报时间，并确定社会回报的多层次预测因素 生态框架。分目标1a将审查追踪的影响(同伴教育者对走失患者的外联) 在回来的时候。AIM 2将收集重新接受艾滋病毒护理的空闲患者的深入访谈数据。绘图 关于目标1中确定的因素和允许其他因素出现的扎根理论，目标2试图解释 与重新参与相关的因素的作用机制。最终结果将被三角化 开发HIV护理重新参与的精细化概念模型，以指导设计和测试 促进回返的干预措施。 奖学金信息：拟议的研究将作为Laura Beres女士的博士论文 目前在约翰·霍普金斯大学国际卫生系攻读博士学位。培训是有指导的 由一名赞助商、两名共同赞助商和一名科学顾问提供艾滋病毒和分析方面的互补专业知识 学习所需的技能。培训包括课程作业、实地研究和其他为MS做好准备的机会。 贝雷斯将成为全球艾滋病毒预防和护理领域的领先独立研究员。

Project Summary / Abstract Background: Patient disengagement from HIV care and treatment programs is a major barrier to treatment optimization in sub-Saharan Africa. While initial studies show that patient re-engagement in care is possible, very little is known about re-engagement patterns, associated factors and how they lead to return to care. Study Objective: The goal of this study is to understand the patterns, predictors and mechanisms of re- engagement in HIV care among adult HIV patients in Zambia in order to inform interventions to support return and subsequent retention. Specific Aims: I. Among a representative, longitudinal cohort of disengaged patients in Zambia, identify time to return and individual (e.g. demographics), relational (e.g. disclosure), household (e.g. wealth), and facility-level (e.g. staffing) factors that predict return to HIV care, comparing disengaged patients who re-engaged in HIV care to those who did not re-engage after being traced. II. Develop a refined conceptual model of the mechanisms of patient re-engagement to guide patient re-engagement support interventions. Approach: The sequential, mixed methods study builds on the applicant’s significant past experience living and contributing to research in Zambia. It leverages the data and infrastructure of an on-going parent study on which the applicant is a co-investigator. The parent study is tracing 5,000 randomly sampled, lost adult HIV patients from 31 health facilities across 4 provinces in Zambia to determine their outcomes: deceased, engaged in care elsewhere or disengaged from care. Aim 1 will be a secondary data analysis of the estimated 1,000 disengaged patients from the parent study, among whom an estimated 25% (n=250) will re-engage in care over 15 months. Survival analysis will be used to estimate time to return and identify multi-level predictors of return across a social ecological framework. Sub-Aim 1a will examine the impact of tracing (peer educator outreach to lost patients) on return. Aim 2 will collect in-depth interview data from disengaged patients who returned to HIV care. Drawing on the factors identified in Aim 1 and grounded theory to allow other factors to emerge, Aim 2 seeks to explain the mechanisms through which factors associated with re-engagement operate. Final results will be triangulated to develop a refined conceptual model of HIV care re-engagement that can guide the design and testing of interventions to facilitate return. Fellowship Information: The proposed research will serve as the doctoral dissertation of Ms. Laura Beres, a current PhD student in the Department of International Health at Johns Hopkins University. The training is guided by one Sponsor, two Co-sponsors and a Scientific Advisor who offer complementary expertise in HIV and analytic skills required for the study. Training includes coursework, field research and other opportunities to prepare Ms. Beres to become a leading independent researcher in global HIV prevention and care.