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

影响赞比亚艾滋病毒患者返回护理的模式和因素

• 批准号: 9565652
• 负责人: Laura Beres
• 金额: $ 4.45万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-16 至 2020-06-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9565652
• 关键词: AIDS prevention; Address; Adult; Affect; Africa; Africa South of the Sahara; Behavior; Behavioral; CD4 Lymphocyte Count; Caring; Characteristics; Code; Computerized Medical Record; Data; Data Analyses; Data Collection; Data Set; Diagnosis; Disclosure; Doctor of Philosophy; Effectiveness; Ensure; Fellowship; Gender; Goals; HIV; HIV drug resistance; Health; Health care facility; Household; Individual; Infectious Diseases Research; International; Intervention; Interview; Lead; Length; Longitudinal cohort; Measures; Methods; Modeling; Morbidity - disease rate; National Research Service Awards; Outcome; Parents; Patient Care; Patients; Pattern; Persons; Population; Postdoctoral Fellow; Predictive Factor; Province; Research; Research Design; Research Infrastructure; Research Methodology; Research Personnel; Research Priority; Risk; Sampling; Schedule; Source; Students; Surveys; Survival Analysis; Testing; Time; Training; United States National Institutes of Health; Universities; Viral; Viremia; Visit; Zambia; antiretroviral therapy; barrier to care; cohort; data modeling; demographics; design; epidemiological model; experience; follow-up; improved; innovation; mortality; outreach; patient engagement; peer; secondary analysis; skills; social; study population; theories; transmission process; treatment optimization; treatment program; treatment response

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.

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，患者可以在护理中重新参与，但 关于重新参与模式，相关因素及其如何导致恢复护理的知识知之甚少。 研究目标：这项研究的目的是了解重新的模式，预测因子和机制 赞比亚的成年艾滋病毒患者参与艾滋病毒护理，以告知干预措施以支持回报 并随后保留。 具体目的：I。在赞比亚的代表性，纵向脱离的患者中，请确定时间 返回和个人（例如人口统计学），关系（例如披露），家庭（例如财富）和设施级别 （例如，人员配备）预测恢复艾滋病毒护理的因素，比较了在艾滋病毒护理中重新参与的患者 对于那些在被追踪后没有重新参与的人。 ii。开发一个精致的概念模型 患者重新参与以指导患者重新参与支持干预措施。 方法：顺序，混合方法研究是基于申请人过去的重要经验生活和 为赞比亚的研究做出贡献。它利用正在进行的父母研究的数据和基础架构 申请人是共同评估器。父母研究正在追踪5,000个随机采样，丢失的成年艾滋病毒患者 来自赞比亚4个省的31个卫生设施，以确定其结果：已故，从事护理 在其他地方或脱离护理。 AIM 1将是估计1,000次脱离的次要数据分析 父母研究的患者，其中估计有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和确定社会回报的多层次预测指标 生态框架。 Sub-aim 1a将检查跟踪的影响（同伴教育者对失落的患者的宣传） 返回。 AIM 2将从返回艾滋病毒护理的脱离脱离患者的深入访谈数据中收集。绘画 关于AIM 1中确定的因素和扎根理论以允许其他因素出现，AIM 2试图解释 与重新参与运营商相关的因素的机制。最终结果将是三角的 开发一种精致的艾滋病毒护理重新参与概念模型，可以指导设计和测试 干预措施以促进回报。 奖学金信息：拟议的研究将作为劳拉·贝雷斯女士的博士论文 约翰·霍普金斯大学国际卫生系现任博士生。训练是指导的 由一位赞助商，两个共同发起人和一名科学顾问，他们提供艾滋病毒和分析方面的完整专业知识 研究所需的技能。培训包括课程工作，现场研究和其他准备女士的机会。 Beres成为全球艾滋病毒预防和护理领域的主要独立研究员。