Building capacity for patient-centered outcomes research to improve the quality and impact of HIV care in Tanzania

摘要 在过去10年中，坦桑尼亚在将抗逆转录病毒治疗扩大到 1.4艾滋病毒感染者（PLWH）。随着获得这些拯救生命的疗法的机会增加， 坦桑尼亚人的寿命更长，这对卫生系统提供长期有效的艾滋病毒护理提出了挑战， 治疗，确保坚持抗逆转录病毒疗法和保留，并充分管理慢性合并症， 患有慢性病的艾滋病毒携带者人数不断增加。满足这一需求将需要重新设计艾滋病毒和 提供初级保健。以患者为中心的护理（PCC）是高质量护理的重要组成部分。 定义为“提供尊重和响应患者个人偏好、需求和 PCC对坦桑尼亚等中低收入国家至关重要， 人口正在从急性疾病向慢性疾病转变。越来越多的艾滋病毒文献表明， PCC在改善患者ART和访视依从性、满意度和生活质量方面的作用。病人为中心 结果研究（PCOR）旨在研究卫生系统和护理服务应如何组织， 确保PCC并改善与患者及其家属最相关的临床和患者报告结局 照顾者在这笔赠款中，我们提议加强坦桑尼亚穆希姆比利大学变革和组织振兴方案的能力， 健康和联合科学（MUHAS）艾滋病毒研究社区的长期目标是将这一 将这一学科纳入研究，以优化达累斯萨拉姆艾滋病毒设施中的PCC，并改善患者和健康状况 系统成果。MUHAS在NIH资助的艾滋病毒研究培训项目方面有着成功的记录， 越来越多的成功的艾滋病毒调查人员在几个艾滋病毒学科和社会的专业知识， 行为科学我们在艾滋病毒和变革和组织振兴方案方面的新型研究培训计划将支持短期、中期和长期的培训。 长期培训与辅导和课程设计方面的能力建设相结合， 以下目标和可持续性计划：目标1。建立MUHAS艾滋病毒方面的能力和专门知识 研究人员在坦桑尼亚设计和开展艾滋病毒变革和组织振兴方案;目标2。培养一个教师领导团队， MUHAS的导师能够为新的艾滋病毒变革和组织振兴方案调查人员提供辅导和培训， 变革和组织振兴方案科学议程;以及目标3。通过正式纳入变革和组织振兴方案，推进国内艾滋病毒变革和组织振兴方案议程 课程纳入现有的研究生学位课程。该补助金将支持6名博士后研究员，2名硕士和 2位博士通过长期和中期变革和组织振兴方案培训，为学生提供培训。变革和组织振兴方案短期技能建设、辅导 将为100多名参与者提供变革和组织振兴方案、导师制和 教学年度研讨会将为更广泛的艾滋病毒调查人员提供机会 传播他们的研究成果并形成新的合作。通过这个项目，我们将实现 目标是培训新一代独立的坦桑尼亚艾滋病毒变革和组织振兴方案调查人员， 这是一条独立之路，并为MUHAS成为坦桑尼亚变革和组织振兴方案的一个卓越中心铺平了道路。

Abstract Over the last 10 years, Tanzania has made significant progress expanding antiretroviral treatment (ART) to the 1.4 million people living with HIV (PLWH). With improved access to these life-saving therapies, PLWH in Tanzania are living longer, challenging the health system to provide long-term effective HIV care and treatment, ensure adherence to ART and retention, and adequately manage chronic co-morbidities in the growing number of PLWH with chronic disease. Meeting this demand will require a redesign of how HIV and primary care are delivered. Patient centered care (PCC) is an essential component of high quality care. Defined as `providing care that is respectful of, and responsive to, individual patient preferences, needs and values', PCC is critical to low and middle-income countries (LMICs) such as Tanzania where the health demographic is changing from more acute to chronic disease. A growing literature in HIV has shown the crucial role of PCC in improving patient ART and visit adherence, satisfaction and quality of life. Patient centered outcomes research (PCOR) is designed to study how health systems and care delivery should be organized to ensure PCC and improve clinical and patient-reported outcomes that are most relevant to patients and their caregivers. In this grant, we propose to strengthen the PCOR capacity of the Tanzanian Muhimbili University of Health and Allied Sciences (MUHAS) HIV research community with a long-term goal of incorporating this discipline into studies to optimize PCC in HIV facilities in Dar es Salaam, and improve patient and health system outcomes. MUHAS has a successful track record of NIH-funded research training programs in HIV with a growing faculty of accomplished HIV investigators with expertise in several HIV disciplines and socio- behavioral sciences. Our novel research training program in HIV and PCOR will support short, medium and long-term trainings combined with capacity building in mentorship and curriculum design to achieve the following aims and plan for sustainability: Aim 1. Build the capacity and expertise in MUHAS HIV researchers to design and conduct PCOR in HIV in Tanzania; Aim 2. Develop a team of faculty leaders and mentors at MUHAS able to provide mentorship and training for new HIV PCOR investigators and sustain the PCOR scientific agenda; and Aim 3. Advance the in-country HIV PCOR agenda by formally integrating PCOR courses into existing graduate degree programs. This grant will support 6 post-doctoral fellows, 2 Masters and 2 Ph.D. students through long and medium-term PCOR trainings. Short-term PCOR skills building, mentorship and teaching and curriculum design workshops will train over 100 participants in PCOR, mentorship and teaching. Annual symposia will provide opportunities for the broader community of HIV investigators to disseminate their research and form new collaborations. Through this program we will achieve the overall goal of training a new generation of independent Tanzanian HIV PCOR investigators, mentoring them on the path to independence and leading the way for MUHAS to become a center of excellence in PCOR in Tanzania.