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

项目总结 背景资料。为实现联合国艾滋病规划署在2030年前控制艾滋病毒流行的95-95-95快速通道目标，战略 必须优先支持艾滋病毒携带者(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)的规模，改善了艾滋病毒的治疗 在人口一级的结果，但艾滋病毒流行和应对的异质性在以下方面产生了差异 病毒载量结果。检查纵向病毒载量结果，以及影响它们的多层次因素，是至关重要的 用于确定艾滋病毒服务的地理优先次序，并区分不同的艾滋病毒感染人群。 学习目标和目的。这项研究的目标是评估模式、预测因素和支撑机制 乌干达拉凯PLHIV患者的纵向病毒载量结果(或轨迹)。这项研究的具体目的 是：1)确定家庭和社区层面的病毒学失败和持久病毒抑制的预测因素 在人口一级的艾滋病毒感染者中；2)检查卫生设施的特点 与病毒学故障相关 在… 设施水平；以及3)探索社会、背景和卫生系统因素 影响病毒载量的结果。拟议的研究与NIMH艾滋病研究优先事项司保持一致 超前设计干预措施，超越个人层面，延长对艾滋病毒护理的参与。 接近。这项说明性的顺序混合方法研究将利用 Rakai社区队列研究(RCCS)，一项开放的、基于人群的队列研究，对象为15-49岁的个人 居住在乌干达拉凯的40个社区。目标1是测试是否钓鱼的次要数据分析 社区居住、较高的社区级别迁移和较低的家庭财富与 在五年的随访中，病毒学失败的风险增加。目标2将把农村信用社的数据与方案相结合 来自161个卫生机构的元数据，用于横断面识别病毒学故障的成分相关性 每个机构的病人数量。在目标1-2调查结果的基础上，目标3将涉及主要的定性数据 通过对20-24名艾滋病病毒感染者和10-12名艾滋病病毒临床医生的深入访谈收集数据。采访将探索 目标1-2中确定的多水平因素的协同作用以及它们如何随时间影响PLHIV的病毒载量结果。 AIMS 1-3的发现将被三角化，以丰富对显著的艾滋病毒治疗差距的科学调查。 团契信息。拟议的研究将作为约瑟夫·罗森先生的博士论文 约翰霍普金斯大学彭博公共卫生学院的博士生。培训由一名小学教师指导 赞助商、三个共同赞助商和一名科学顾问，具有互补的方法和专题 专业知识，包括乌干达Rakai的PLHIV护理和治疗结果研究。培训计划将 让罗森先生做好准备，成为社会和行为科学领域的领先独立研究员，专注于 关于撒哈拉以南非洲支持参与和保留艾滋病毒护理的干预措施。

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.