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

项目总结/摘要 背景：患者脱离HIV护理和治疗计划是治疗的主要障碍 撒哈拉以南非洲的最佳化。虽然初步研究表明，病人重新参与护理是可能的， 人们对重新参与的模式、相关因素及其如何导致重新接受护理知之甚少。 研究目的：本研究的目的是了解再狭窄的模式、预测因素和机制。 参与赞比亚成年艾滋病毒患者的艾滋病毒护理，以便为支持返回的干预措施提供信息 以及随后的保留。 具体目标：一。在赞比亚的一个具有代表性的脱离患者纵向队列中，确定 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 (e.g.人员配置）因素，预测返回艾滋病毒护理，比较脱离的病人谁重新从事艾滋病毒护理 那些在被追踪后没有重新参与的人。二.制定一个关于生物多样性机制的精确概念模型， 患者重新参与，以指导患者重新参与支持干预。 方法：顺序，混合方法的研究建立在申请人的重要过去的生活经验， 为赞比亚的研究做出贡献。它利用了正在进行的母公司研究的数据和基础设施， 申请人是共同研究者。这项母体研究追踪了5,000名随机抽样的、失踪的成年艾滋病患者 来自赞比亚4个省的31个卫生设施，以确定其结果：死亡，从事护理 在其他地方或脱离照顾。目标1将是对估计1，000名脱离接触人员的二级数据分析 来自母研究的患者，其中估计25%（n=250）将在15个月内重新参与护理。 生存分析将用于估计返回的时间，并确定社会回归的多层次预测因素。 生态框架次级目标1a将审查追踪的影响（同伴教育者对走失病人的宣传） 回来的时候。目标2将从返回艾滋病毒护理的脱离患者中收集深入访谈数据。绘图 在目标1中确定的因素和允许其他因素出现的扎根理论上，目标2试图解释 与重新参与相关的因素发挥作用的机制。最终结果将进行三角测量 制定一个完善的艾滋病毒护理重新参与的概念模型，可以指导设计和测试， 采取干预措施，促进回返。 奖学金信息：拟议的研究将作为Laura Beres女士的博士论文， 约翰霍普金斯大学国际卫生系博士生。培训指导 由一名赞助商、两名共同赞助商和一名科学顾问组成，他们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，实地研究和其他机会，以准备女士。 贝雷斯将成为全球艾滋病预防和护理领域领先的独立研究人员。

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.