What happens after diagnosis: Characterizing long-term HIV care trajectories and mortality in South Africa
诊断后会发生什么:描述南非长期艾滋病毒护理轨迹和死亡率
基本信息
- 批准号:9140315
- 负责人:
- 金额:$ 45.17万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2016
- 资助国家:美国
- 起止时间:2016-04-07 至 2020-03-31
- 项目状态:已结题
- 来源:
- 关键词:AcademiaAchievementAfrica South of the SaharaBehavioralBehavioral ModelBehavioral SciencesBiometryCD4 Lymphocyte CountCaringCensusesCessation of lifeClinicalCohort StudiesCommunitiesConsentContinuity of Patient CareDataData SourcesDiagnosisDiseaseEffectivenessEmotionalFundingFutureGeographic FactorGeographic Information SystemsGeographic LocationsGovernmentHIVHIV diagnosisHealthHealth BenefitHealthcare SystemsHot SpotHuman immunodeficiency virus testIndividualInterventionLaboratoriesLifeLife ExpectancyLong-Term CareLongitudinal StudiesMeasuresMonitorMorbidity - disease rateMovementNational Institute of Mental HealthNatureNewly DiagnosedNonlinear DynamicsOutcomeParticipantPatientsPatternPatterns of CarePerformancePhysiciansPlayPopulationPositioning AttributePublic HealthRegistriesReportingResearchResearch PersonnelResourcesRisk FactorsServicesSocial BehaviorSocial supportSouth AfricaSouth AfricanStagingStatistical Data InterpretationStatistical ModelsStudy SubjectTestingTimeViral Load resultWorkantiretroviral therapybaseclinical epidemiologyclinical research sitecohortdesigneffective interventionhealth service usehigh riskimprovedinnovationmortalitynovelnovel strategiespreventprogramspublic health relevancesocialsuccesstherapy adherencetherapy designtooltransmission processtreatment programtreatment siteuptake
项目摘要
DESCRIPTION (provided by applicant): Widespread uptake of potent antiretroviral therapy (ART) for HIV holds the promise of reducing morbidity and HIV transmission - but requires consistent engagement with the health care system. South Africa has the largest ART program in the world, with 2.4 million people on treatment. Yet despite this unprecedented accomplishment, UNAIDS estimates that ~60% of people in South Africa in need of treatment are still not accessing ART. This reflects attrition from the multiple critical steps on the path fom HIV testing to linkage to HIV care to lifelong ART and virologic suppression. Previous research on patient attrition from the HIV care cascade has focused on cross-sectional snapshots of points on the care continuum. This approach fails to capture long-term, dynamic patient movement into and out of the cascade. Improvement in each step of the continuum must be achieved together to improve overall rates of virologic suppression and survival. Only by understanding patient, structural, and geographic factors that contribute to suboptimal progression through the continuum of care can we design effective interventions that target those at highest risk for poor care engagement. Innovative means of assessing patient progression longitudinally and across different treatment sites are needed to assess the dynamic, non-linear nature of the HIV care continuum. Leveraging a well-characterized cohort of nearly 2,000 HIV-infected people drawn from an NIMH- funded trial in South Africa (R01MH090326), we will assess 5-year HIV care trajectories, characterizing patients via group-based statistical modeling based on a combination of national laboratory data and death registry information. Because cohort study subjects were consented prior to HIV testing, in a variety of clinical sites and with a wide spectrum of presenting CD4 counts, we will be able to characterize risk factors for different long-term trajectories for a wide variety of patient types. In addition,we will define geographic areas associated with poor engagement in care using spatial analysis of care trajectories and 2011 South African census data. We propose the following three specific aims: (1) To assess rates and sociobehavioral predictors of 5-year mortality following HIV testing adjusting for baseline and 9-month clinical factors, (2) To identify distinct long-term HIV
care trajectories based on the pattern of CD4 counts and viral loads (such as in care, care interrupters, and not in care) and to assess sociobehavioral factors associated with membership in one of these trajectories, and (3) To use geographic information system and spatial statistical analysis to identify "hot spots" associated with a higher likelihood of inconsistent long-term HIV care trajectories and higher mortality. This study will be among the first to examine longitudinal
engagement in care for people newly- diagnosed with HIV. Our novel approach will help researchers and policymakers craft effective interventions targeting sub-populations of HIV-infected individuals and geographic areas with a higher likelihood of poor HIV care engagement. These findings can improve HIV care at the individual, program and community levels.
描述(由申请人提供):广泛采用有效的艾滋病毒抗逆转录病毒疗法(ART)有望降低发病率和艾滋病毒传播,但需要卫生保健系统的持续参与。南非拥有世界上最大的 ART 项目,有 240 万人正在接受治疗。然而,尽管取得了前所未有的成就,联合国艾滋病规划署估计,南非约 60% 需要治疗的人仍然没有获得抗逆转录病毒治疗。这反映了从艾滋病毒检测到艾滋病毒护理到终身抗逆转录病毒治疗和病毒学抑制的多个关键步骤的消耗。先前关于艾滋病毒护理级联中患者流失的研究主要集中在护理连续体上各个点的横截面快照上。这种方法无法捕捉长期、动态的患者进出级联的运动。连续体的每个步骤的改进必须共同实现,以提高病毒学抑制率和生存率的总体水平。只有了解在连续护理过程中导致进展不理想的患者、结构和地理因素,我们才能设计有效的干预措施,针对那些护理参与度不佳风险最高的人群。需要纵向和跨不同治疗地点评估患者进展的创新方法,以评估艾滋病毒护理连续体的动态、非线性性质。 我们将利用从 NIMH 资助的南非试验 (R01MH090326) 中抽取的近 2,000 名 HIV 感染者的详细特征队列,评估 5 年 HIV 护理轨迹,通过基于组的统计模型(基于国家实验室数据和死亡登记信息相结合)来描述患者特征。由于队列研究受试者在 HIV 检测前已获得同意,且在不同的临床场所进行,并且具有广泛的 CD4 计数,因此我们将能够描述各种患者类型的不同长期轨迹的危险因素。此外,我们将利用护理轨迹的空间分析和 2011 年南非人口普查数据来定义与护理参与度低相关的地理区域。我们提出以下三个具体目标:(1) 评估 HIV 检测后 5 年死亡率的比率和社会行为预测因素,调整基线和 9 个月的临床因素,(2) 确定不同的长期 HIV
基于 CD4 计数和病毒载量模式(例如在护理中、护理中断者中和不在护理中)的护理轨迹,并评估与这些轨迹之一的成员资格相关的社会行为因素,以及 (3) 使用地理信息系统和空间统计分析来识别与长期不一致的 HIV 护理轨迹和较高死亡率相关的“热点”。 这项研究将是第一个纵向检验的研究
参与对新诊断出的艾滋病毒感染者的护理。我们的新颖方法将帮助研究人员和政策制定者针对艾滋病毒感染者亚群和艾滋病毒护理参与度较差的可能性较高的地理区域制定有效的干预措施。这些发现可以改善个人、项目和社区层面的艾滋病毒护理。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Ingrid Valerie Bassett其他文献
Ingrid Valerie Bassett的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Ingrid Valerie Bassett', 18)}}的其他基金
Mentoring in patient-oriented research on HIV and global health
指导以患者为中心的艾滋病毒和全球健康研究
- 批准号:
9889026 - 财政年份:2019
- 资助金额:
$ 45.17万 - 项目类别:
Mentoring in patient-oriented research on HIV and global health
指导以患者为中心的艾滋病毒和全球健康研究
- 批准号:
9790038 - 财政年份:2019
- 资助金额:
$ 45.17万 - 项目类别:
Mentoring in patient-oriented research on HIV and global health
指导以患者为中心的艾滋病毒和全球健康研究
- 批准号:
10338169 - 财政年份:2019
- 资助金额:
$ 45.17万 - 项目类别:
Mentoring in patient-oriented research on HIV and global health
指导以患者为中心的艾滋病毒和全球健康研究
- 批准号:
10570265 - 财政年份:2019
- 资助金额:
$ 45.17万 - 项目类别:
South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact
南非新的中央慢性药物配发和分配计划:评估诊所、患者和社区的影响
- 批准号:
10194606 - 财政年份:2018
- 资助金额:
$ 45.17万 - 项目类别:
South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact
南非新的中央慢性药物配发和分配计划:评估诊所、患者和社区的影响
- 批准号:
10413904 - 财政年份:2018
- 资助金额:
$ 45.17万 - 项目类别:
South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact
南非新的中央慢性药物配发和分配计划:评估诊所、患者和社区的影响
- 批准号:
9751392 - 财政年份:2018
- 资助金额:
$ 45.17万 - 项目类别:
Test and Treat TB: A Proof of Concept Trial in South Africa
测试和治疗结核病:南非的概念验证试验
- 批准号:
8739080 - 财政年份:2014
- 资助金额:
$ 45.17万 - 项目类别:
Test and Treat TB: A Proof of Concept Trial in South Africa
测试和治疗结核病:南非的概念验证试验
- 批准号:
8887097 - 财政年份:2014
- 资助金额:
$ 45.17万 - 项目类别:
Linkage & Retention: A Randomized Trial to Optimize HIV/TB Care in South Africa
连锁
- 批准号:
8462802 - 财政年份:2010
- 资助金额:
$ 45.17万 - 项目类别:
相似海外基金
Collaborative Research: Using Adaptive Lessons to Enhance Motivation, Cognitive Engagement, And Achievement Through Equitable Classroom Preparation
协作研究:通过公平的课堂准备,利用适应性课程来增强动机、认知参与和成就
- 批准号:
2335802 - 财政年份:2024
- 资助金额:
$ 45.17万 - 项目类别:
Standard Grant
Collaborative Research: Using Adaptive Lessons to Enhance Motivation, Cognitive Engagement, And Achievement Through Equitable Classroom Preparation
协作研究:通过公平的课堂准备,利用适应性课程来增强动机、认知参与和成就
- 批准号:
2335801 - 财政年份:2024
- 资助金额:
$ 45.17万 - 项目类别:
Standard Grant
A Longitudinal Study of the Relationship between Participation in a Comprehensive Exercise Program and Academic Achievement
参加综合锻炼计划与学业成绩之间关系的纵向研究
- 批准号:
24K14615 - 财政年份:2024
- 资助金额:
$ 45.17万 - 项目类别:
Grant-in-Aid for Scientific Research (C)
Collaborative Research: Characterizing Best Practices of Instructors who Have Narrowed Performance Gaps in Undergraduate Student Achievement in Introductory STEM Courses
合作研究:缩小本科生 STEM 入门课程成绩差距的讲师的最佳实践
- 批准号:
2420369 - 财政年份:2024
- 资助金额:
$ 45.17万 - 项目类别:
Standard Grant
Collaborative Research: Using Adaptive Lessons to Enhance Motivation, Cognitive Engagement, And Achievement Through Equitable Classroom Preparation
协作研究:通过公平的课堂准备,利用适应性课程来增强动机、认知参与和成就
- 批准号:
2335800 - 财政年份:2024
- 资助金额:
$ 45.17万 - 项目类别:
Standard Grant
WTG: Diffusion of Research on Supporting Mathematics Achievement for Youth with Disabilities through Twitter Translational Visual Abstracts
WTG:通过 Twitter 翻译视觉摘要传播支持残疾青少年数学成就的研究
- 批准号:
2244734 - 财政年份:2023
- 资助金额:
$ 45.17万 - 项目类别:
Standard Grant
The Impact of Emotional Experiences of Pride on Long-Term Goal Achievement Behaviors in Elite Athletes
骄傲的情感体验对优秀运动员长期目标实现行为的影响
- 批准号:
23K16740 - 财政年份:2023
- 资助金额:
$ 45.17万 - 项目类别:
Grant-in-Aid for Early-Career Scientists
Meta-Analysis of the Instructional-Relational Model of Student Engagement and Math Achievement: A Moderation and Mediation Approach
学生参与度和数学成绩的教学关系模型的元分析:一种调节和中介方法
- 批准号:
2300738 - 财政年份:2023
- 资助金额:
$ 45.17万 - 项目类别:
Standard Grant
Improving maths achievement in children with speech, language, and communication needs through 'collaborative vocabulary teaching'
通过“协作词汇教学”提高有言语、语言和交流需求的儿童的数学成绩
- 批准号:
2890475 - 财政年份:2023
- 资助金额:
$ 45.17万 - 项目类别:
Studentship
HSI Institutional Transformation Project: Retention and Achievement for Introductory STEM English Learners (RAISE)
HSI 机构转型项目:STEM 英语入门学习者的保留和成就 (RAISE)
- 批准号:
2225178 - 财政年份:2023
- 资助金额:
$ 45.17万 - 项目类别:
Continuing Grant