A mixed methods approach to address multi-level barriers to care for migratory men living with HIV in South Africa

项目总结 艾滋病毒在撒哈拉以南非洲的传播历史上一直伴随着人口在内部和跨地区的流动 国家边界。在南非的城市中心，这一点最为明显，那里的建筑群 世界上最大的艾滋病毒流行与种族隔离下被迫流离失所的遗产之间的相互作用 导致了大量的“国内移民”(那些在国内流动的人) 在整个艾滋病毒护理连续体中持续存在风险。大多数是迁徙到城市中心的男性 找工作。移民男性不仅面临着与流动性相关的内在挑战，而且他们 还应对不断变化的内部和社会结构的男子气概影响参与 关心。鉴于男性艾滋病毒携带者的死亡率是女性的两倍，迫切需要 确定能够有效联系和留住艾滋病毒携带者移徙男子接受护理的干预措施。 目前的建议利用了哈佛医学院和 卫生经济学和流行病学研究办公室(HE2RO)的目标是解决独特的 南非艾滋病毒携带者体内男性所经历的障碍。我们将使用顺序混合- 方法设计要解决以下具体目标：(1)通过半结构化的深入探索 居住在国内的男性移民中的访谈、参与和保留艾滋病毒护理的多层次障碍 未获得护理的艾滋病毒携带者(n=30)；(2)获得优先的艾滋病毒治疗和护理属性以及 服务交付功能，并探索推动他们选择首选方案的特征 离散选择实验(n=200)；和(3)与我们的参与者共同设计干预方案 和主要利益攸关方利用设计思维促进艾滋病毒护理方面的联系和持续参与。 这项提案是对PA-19-050的回应，重点是“让男性参与艾滋病毒检测、预防和 新的NIH关注人类流动性和艾滋病毒，以及南非国家战略计划 艾滋病毒和艾滋病、性传播感染和结核病。R21可能会产生重大影响，因为它会产生证据 支持一个多层次的干预方案，以改善艾滋病毒护理中的吸收和保留，以应对 在艾滋病毒高流行率的城市背景下，南非移民男子的独特需求。这个多- 学科团队拥有跨学科的专业知识和公认的难以接触的记录 社区中的人群需要进行这项研究。

PROJECT SUMMARY The spread of HIV in sub‐Saharan Africa has historically followed population movement within and across country borders. Nowhere is this more evident than in urban centers in South Africa, where the complex interaction between the world’s largest HIV epidemic and a legacy of forced displacement under Apartheid has resulted in a significant population of “internal migrants” (those who move within country) who bear sustained risks across the entire HIV care continuum. The majority are men who migrate to urban centers seeking employment. Not only do migrant men face intrinsic challenges associated with mobility, but they also contend with changing internal and societal constructions of masculinity influencing engagement in care. Given that men with HIV have a two-fold higher mortality rate than women, there is an urgent need to identify interventions that can effectively link and retain migrant men living with HIV to care. The current proposal leverages an established partnership between Harvard Medical School and The Health Economics and Epidemiology Research Office (HE2RO) with the goal of addressing the unique barriers experienced by internal male men living with HIV in South Africa. We will use a sequential mixed- methods design to address the following specific aims: (1) To explore, through semi-structured in-depth interviews, multi-level barriers to engagement and retention in HIV care among internal male migrants living with HIV who are not accessing care (n=30); (2) To elicit preferred HIV treatment and care attributes and service delivery features and explore characteristics driving their selection of preferred scenarios using a Discrete Choice Experiment (n=200); and (3) To co-design an intervention package with our participants and key stakeholders to promote linkage and sustained engagement in HIV care using Design Thinking. This proposal is responsive to PA-19-050, focused on “Engaging Men in HIV Testing, Prevention, and Care,” the new NIH focus on Human Mobility and HIV, and the South African National Strategic Plan for HIV and AIDS, STIs and TB. This R21 has the potential for a significant impact by generating evidence to support a multi-level intervention package to improve uptake and retention in HIV care that is responsive to the unique needs of South African migrant men in a high HIV prevalence urban setting. This multi- disciplinary team has the cross-disciplinary expertise and proven track-record of engaging hard-to-reach populations in the communities needed to execute this study.