Viral Load Trajectories and Dynamics among People Living with HIV in Rakai, Uganda: A Mixed-Methods Study

乌干达拉凯艾滋病毒感染者的病毒载量轨迹和动态：一项混合方法研究

• 批准号: 10327102
• 负责人: Joseph Gregory Rosen
• 金额: $ 4.6万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-02 至 2024-04-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10327102
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Advanced Development; Africa South of the Sahara; Automobile Driving; Behavioral Research; Behavioral Sciences; Caring; Catchment Area; Characteristics; Clinical; Cohort Studies; Communities; Data; Data Analyses; Data Collection; Decision Making; Epidemic; Epidemiology; Failure; Fellowship; Fishes; Funding; Geography; Goals; HIV; Health care facility; Health system; Heterogeneity; Household; Individual; Intercept; Intervention; Interview; Linear Regressions; Measures; Mentorship; Metadata; Methodology; Methods; Modeling; Modification; National Institute of Mental Health; Outcome; Outcomes Research; Patients; Pattern; Policies; Population; Prevalence; Prospective Studies; Public Health Schools; Recording of previous events; Regimen; Research; Research Personnel; Research Priority; Risk; Sampling; Scientific Inquiry; Services; Shapes; Social Sciences; Surveys; Techniques; Testing; Time; Training; Treatment outcome; Uganda; Viral; Viral Load result; Viremia; Visit; aged; antiretroviral therapy; base; care outcomes; cohesion; cohort; contextual factors; data infrastructure; data integration; demographic disparity; design; doctoral student; experience; follow-up; improved; innovation; insight; men; migration; novel; patient population; population based; programs; prospective; residence; response; scale up; service delivery; skills; social; synergism; therapy adherence; therapy design; therapy development; treatment adherence; treatment optimization; virology

PROJECT SUMMARY Background. To meet the UNAIDS 95-95-95 Fast Track targets for HIV epidemic control by 2030, strategies that support people living with HIV (PLHIV) to achieve and maintain viral suppression must be prioritized. Rapid scale-up of antiretroviral therapy (ART) through Universal Test and Treat policies has improved HIV treatment outcomes at population level, but heterogeneities in the HIV epidemic and response have yielded disparities in viral load outcomes. Examining longitudinal viral load outcomes, and the multilevel factors shaping them, is vital for geographic prioritization and differentiation of HIV services to distinct groups of PLHIV. Study Goal and Aims. The goal of this study is to assess patterns, predictors, and mechanisms underpinning longitudinal viral load outcomes (or trajectories) among PLHIV in Rakai, Uganda. The specific aims of this study are to: 1) Identify household and community-level predictors of virologic failure and durable viral suppression among PLHIV at population level; 2) Examine health facility characteristics associated with virologic failure at facility level; and 3) Explore the mechanisms through which social, contextual, and health systems factors influence viral load outcomes. The proposed research aligns with NIMH Division of AIDS Research priorities to advance design of interventions, delivered beyond the individual level, prolonging engagement in HIV care. Approach. This explanatory, sequential mixed-methods study will leverage the data and infrastructure of the Rakai Community Cohort Study (RCCS), an open, population-based cohort study of individuals aged 15-49 years residing in 40 communities in Rakai, Uganda. Aim 1 is a secondary data analysis testing whether fishing community residence, higher community-level migration, and lower household wealth are associated with increased risk of virologic failure over five years of follow-up. Aim 2 will integrate RCCS data with programmatic metadata from 161 health facilities to cross-sectionally identify compositional correlates of virologic failure in each facility’s patient population. Building on findings from Aims 1-2, Aim 3 will involve primary qualitative data collection through in-depth interviews with 20-24 PLHIV and 10-12 HIV clinicians. Interviews will explore synergies in multilevel factors identified in Aims 1-2 and how they shape PLHIV’s viral load outcomes over time. Findings from Aims 1-3 will be triangulated to enrich scientific inquiry into salient HIV treatment gaps. Fellowship Information. The proposed research will serve as the doctoral dissertation of Mr. Joseph Rosen, a PhD student at the Johns Hopkins Bloomberg School of Public Health. The training is guided by one Primary Sponsor, three Co-Sponsors, and one Scientific Advisor with complementary methodological and topical expertise, including care and treatment outcomes research with PLHIV in Rakai, Uganda. The training plan will prepare Mr. Rosen to become a leading independent researcher in the social and behavioral sciences, focused on interventions in sub-Saharan Africa supporting engagement and retention in HIV care.

项目摘要 背景为了实现联合国艾滋病规划署95-95-95到2030年控制艾滋病毒流行病的快速通道目标， 必须优先考虑支持艾滋病毒感染者（PLHIV）实现和维持病毒抑制。快速 通过普遍检测和治疗政策扩大抗逆转录病毒疗法（ART），改善了艾滋病毒治疗 在人口一级取得的成果，但艾滋病毒流行和反应的异质性导致了 病毒载量结果。检查纵向病毒载量结果以及形成它们的多层次因素至关重要 为不同的艾滋病毒感染者群体提供地域优先和差别化的艾滋病毒服务。 研究目的和目标。本研究的目的是评估模式，预测因子和机制， 纵向病毒载量的结果（或轨迹）之间的艾滋病毒感染者在Rakai，乌干达。本研究的具体目的 1）确定家庭和社区水平的病毒学失败和持久病毒抑制的预测因子 （2）检查卫生设施的特点 与病毒学失败有关 在 设施水平; 3）探索社会、环境和卫生系统因素的机制 影响病毒载量结果。拟议的研究与NIMH艾滋病研究部门的优先事项保持一致， 提前设计干预措施，在个人层面之外提供，延长对艾滋病毒护理的参与。 Approach.这种解释性的、连续的混合方法研究将利用 Rakai社区队列研究（RCCS），一项针对15-49岁人群的开放性、基于人群的队列研究 居住在乌干达Rakai的40个社区。目标1是一个次要的数据分析测试是否捕鱼 社区居住、社区水平较高的移民和较低的家庭财富与以下因素有关： 在五年的随访中，病毒学失败的风险增加。目标2将把RCCS数据与方案数据相结合， 来自161个卫生机构的元数据，以横断面方式确定病毒学失败的组成相关性， 每个机构的患者人数在目标1-2调查结果的基础上，目标3将涉及初级定性数据 通过与20-24名艾滋病毒感染者和10-12名艾滋病毒临床医生的深入访谈收集。采访将探讨 目标1-2中确定的多层次因素的协同作用，以及它们如何随着时间的推移塑造PLHIV的病毒载量结果。 将对目标1-3的结果进行三角分析，以丰富对艾滋病毒治疗方面突出差距的科学调查。 奖学金信息。拟议的研究将作为约瑟夫罗森先生的博士论文， 约翰霍普金斯布隆伯格公共卫生学院博士生。培训由一个主要的 申办者、三名联合申办者和一名科学顾问，提供补充的方法学和主题 在乌干达的Rakai，艾滋病毒感染者的护理和治疗结果研究。培训计划将 准备先生罗森成为一个领先的独立研究员在社会和行为科学，重点 在撒哈拉以南非洲采取干预措施，支持参与和保留艾滋病毒护理。