Syndemics and Loss From the HIV Care Continuum in India

印度艾滋病毒护理连续体的流行病和损失

• 批准号: 9204114
• 负责人: Brian Tan Chan
• 金额: $ 19.7万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-01 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9204114
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Anti-Retroviral Agents; Award; Behavior Therapy; Caring; Child Development; Child Sexual Abuse; Clinical; Clinical Trials; Communicable Diseases; Complement; Complex; Continuity of Patient Care; Country; Crime; Data; Development; Education; Enrollment; Epidemic; Equation; Food; Goals; HIV; HIV risk; Health; Income; India; Infectious Disease Epidemiology; International; Intervention; Intervention Trial; Interview; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Modeling; Morbidity - disease rate; Outcome; Patients; Peer Review; Positioning Attribute; Poverty; Prevention; Prospective cohort study; Provider; Public Health; Qualitative Methods; Records; Research; Research Infrastructure; Research Personnel; Risk; Risk Factors; Structure; Testing; Training; United States National Institutes of Health; Violence; Woman; World Bank; career; clinical infrastructure; cohort; design; effective intervention; experience; gender-based violence; improved; improved outcome; innovation; interest; intervention effect; journal article; low and middle-income countries; men who have sex with men; mortality; multi-component intervention; operation; prevent; psychosocial; social; theories; therapy design; therapy development; trial design; virology; virtual

PROJECT SUMMARY In India, which has the world's third largest HIV epidemic, loss from the HIV care continuum leads to excess morbidity and mortality among people living with HIV (PLHIV) and jeopardizes the promise of "treatment as prevention.” Our understanding of the causes of loss to HIV care in India, however, is extremely limited. Common, co-morbid psychosocial and structural conditions—including depression, violence, poverty, and food insecurity—may be important factors contributing to loss to care in India. Because these conditions often co-occur and are driven by common structural and social forces, the term “syndemics” has been applied to refer to the ways in which these conditions interact with each other and mutually reinforce their adverse impacts on HIV treatment and prevention. Syndemic theory has mainly been applied to explain HIV risk among men who have sex with men in high-income countries, but few studies have examined the effect of syndemic conditions on HIV-related health outcomes in low- and middle-income countries such as India. My long-term career goal is to understand the impact of syndemic conditions on HIV-related outcomes, including loss from the HIV care continuum, and to develop effective interventions targeting the barriers to care presented by these syndemic conditions. To achieve this goal, I will need additional mentorship and training in qualitative methods, complex modeling approaches, and intervention development for the Indian context. Drawing upon this training and my previous research in this field, I will conduct a study at the YR Gaitonde Centre for AIDS Research and Education in Chennai, India with the goal of achieving my scientific objective: an understanding of the impact of syndemic conditions on loss from the HIV care continuum and the development of a pilot intervention for syndemic-affected PLHIV at risk for loss to care. My central hypothesis is that syndemic conditions are associated with loss to care and lack of virologic suppression among PLHIV in India. I further hypothesize that a pilot intervention targeting syndemic-affected PLHIV will be feasible and acceptable to patients and providers. To test these hypotheses, I will pursue the following 3 specific research aims: 1) conduct qualitative interviews to refine a model of syndemic conditions contributing to loss to care among PLHIV in Chennai, India; 2) estimate the impact of syndemic conditions on loss to care and lack of virologic suppression among PLHIV in India; and 3) develop and pilot-test an intervention to prevent loss to care and lack of virologic suppression among syndemic-affected Indian PLHIV. I am well positioned to achieve these aims given my previous research experience with syndemic conditions in LMICs including in India as well as an internationally renowned mentorship team with expertise in qualitative methods, complex modeling approaches, syndemic theory, and behavioral interventions. The proposed research is innovative and significant as the results will help policymakers identify Indian PLHIV at risk for loss to care and design effective, multi-faceted interventions addressing syndemic conditions to keep Indian PLHIV in care and virologically suppressed.

项目摘要 在世界上拥有世界第三大艾滋病毒流行病的印度，艾滋病毒护理连续体的损失导致 艾滋病毒（PLHIV）患者的发病率和死亡率过多，并危害了 “预防治疗。”但是，我们对印度损失艾滋病毒护理损失的原因的理解是极其的 有限的。常见的，合并的社会心理和结构状况 - 包括抑郁，暴力，贫穷， 和粮食不安全 - 可能是导致印度损失护理的重要因素。因为这些条件 经常同时发生，并由共同的结构和社会力量驱动，“ Syndemics”一词已被应用 指指这些条件相互作用并相互加强的方式 对艾滋病毒治疗和预防的影响。联合理论主要用于解释艾滋病毒的风险 在高收入国家与男性发生性关系的男性，但很少有研究检查集团的影响 印度等低收入和中等收入国家与HIV相关的健康状况的条件。我的长期 职业目标是了解联合疾病对HIV相关结果的影响，包括损失 HIV护理连续性，并制定针对针对护理障碍的有效干预措施 这些合成条件。为了实现这一目标，我将需要定性的其他心态和培训 印度背景下的方法，复杂的建模方法和干预开发。吸引 这项培训和我以前在该领域的研究，我将在YR Gaitonde AIDS中心进行研究 印度钦奈的研究和教育目的是实现我的科学目标：理解 联合疾病对艾滋病毒护理连续体损失的影响和飞行员的发展 受辛迪克受到损失损失护理风险的干预措施。我的中心假设是集团 条件与印度PLHIV之间的护理丧失和缺乏病毒性抑制有关。我进一步 假设针对受象征性PLHIV的试验干预是可行的，并且可以接受 病人和提供者。为了检验这些假设，我将追求以下3个具体研究目的：1） 进行定性访谈，以完善造成损失护理的联合状况模型 印度钦奈的PLHIV； 2）估计联合条件对护理损失和缺乏病毒学的影响 印度PLHIV的抑制； 3）开发和试点测试一项干预措施，以防止损失护理和 受辛迪克血管影响的印度PLHIV缺乏病毒学抑制。我有能力实现这些 鉴于我以前在LMIC中的联合疾病的研究经验，包括印度以及 一支具有定性方法专业知识的国际知名巡回精神团队，复杂的建模 方法，联合理论和行为干预措施。拟议的研究是创新的， 意义重大，因为结果将有助于决策者确定印度人有损失护理和设计的风险 有效，多方面的干预措施，以解决联合疾病，以使印度PLHIV保持护理和 病毒学抑制。