Using Information to Align Services and Link and Retain Men in the HIV Cascade

 描述（由申请人提供）：在南非，世界上艾滋病毒感染负担最重的国家，男性无法获得或过早退出艾滋病毒检测，治疗和护理的“级联”，其比率远远高于女性。将男性与早期护理联系起来，并使他们保持更长时间的坚持，不仅会改善他们自己的健康，而且还将直接转化为一系列更好的健康结果， 家庭和社区。男性退出艾滋病毒感染的原因有很多，但有两个关键因素：1）卫生系统内各种艾滋病毒相关服务的分散性，以及2）卫生系统和社区为支持艾滋病毒感染者或试图避免艾滋病毒感染者所做的努力之间持续存在差距。干预措施很少，特别是 来解决这两个关键的差距。这个项目-利用信息协调服务，将男子与艾滋病毒连锁反应联系起来，并将其留住-或称“i-ALARM”，旨在对这一未得到充分认识但又迫切需要的问题“敲响警钟”，并制定利用卫生信息更有效地协调卫生系统和社区服务提供者工作的方法。其具体目标是：（1）了解现有男性艾滋病毒级联的表现，并确定影响男性通过这一级联流动的规模和速度的因素，（2）制定一项卫生信息管理干预措施，将诊所和社区提供者聚集在一起，改善这一级联的表现，3）试验这种干预措施，并评估它以何种方式a）改善诊所和社区服务之间的沟通和协调，B）导致服务设计和提供的变化，以及c）改善男子与艾滋病毒护理的联系和保留。为了实现目标1，我们将在开普敦卫生分区使用定性形成性研究和回顾性和前瞻性队列队列研究对当地男性艾滋病毒级联进行混合方法研究。为了实现目标2，我们将与健康信息和管理专家协商，制定HIM干预措施，并与开普敦社区的诊所和社区提供者合作，建立一个“男性联系和保留护理工作组”（LRTT）。在目标3中，我们将支持LRTT试点HIM干预，并使用混合方法对试点进行评估，并使用目标1中开始的前瞻性队列研究的结果进行结果评估。该项目具有创新性，不仅利用艾滋病毒级联作为总体概念框架，而且在干预措施中将其具体化，使诊所和社区利益攸关方聚集在一起，促进协调他们的努力，以联系和留住男子。我们希望i-ALARM将产生一个工作模型-可扩展和可转移到其他健康问题和设置-诊所和社区利益相关者之间的健康信息管理如何产生创新和可持续的响应关键的公共卫生需求。

 DESCRIPTION (provided by applicant): In South Africa, the country with the highest burden of HIV infection in the world, men either fail to access or drop out early from the 'cascade' of HIV testing, treatment and care at considerably higher rates than women. Linking men to care earlier, and keeping them retained and adherent for longer, will improve not only their own health, but will also directly translate into a range of better health outcomes for their partners, families and communities. There are many reasons men drop out of the HIV cascade but two critical factors are 1) the fragmentation within the health system across its various HIV-related services, and 2) a persistent gap between health system- and community-based efforts to support those living with-or trying to avoid-HIV infection. Few interventions exist, especially for men, to address these two critical gaps. This project-Using Information to Align Services and Link and Retain Men in the HIV Cascade-or 'i-ALARM', seeks to 'raise the alarm' about this under-recognized but urgent need, and to develop ways of using health information to more effectively coordinate the work of health system and community service providers. Its specific aims are 1) to understand the performance of the existing HIV cascade for men, and determine the factors affecting the scale and pace of men's movement through this cascade, 2) to develop a health information management (HIM) intervention that brings clinic and community-based providers together to improve the performance of this cascade, and 3) to pilot this intervention and evaluate in what ways it a) improves communication and coordination among clinic and community services, b) leads to changes in service design and delivery, and c) improves men's linkage to and retention in HIV care. To achieve Aim 1, we will conduct a mixed methods study of the local HIV cascade for men in a Cape Town health sub-district using qualitative formative research and a cohort study with retrospective and prospective cohorts. To achieve Aim 2, we will consult with health information and management experts to develop the HIM intervention and work with clinic and community providers already working together in a Cape Town community to establish a 'Men's Linkage and Retention in Care Task Team' (LRTT). In Aim 3, we will support the LRTT in piloting the HIM intervention and conduct an evaluation of this pilot, using both a mixed methods process evaluation of the pilot and an outcomes evaluation using the findings from the prospective cohort study begun in Aim 1. This project is innovative for not only using the HIV cascade as an overarching conceptual framework, but for operationalizing it concretely in an intervention that brings clinic and community stakeholders together to catalyze coordination of their efforts to link and retain men in care. We expect i-ALARM will produce a working model-up-scalable and transferable to other health problems and settings-for how health information management between clinic and community stakeholders can produce innovative and sustainable responses to critical public health needs.