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

项目摘要 艾滋病毒在撒哈拉以南非洲的传播历史上一直伴随着内部和外部的人口流动。 国家边界。这一点在南非的城市中心最为明显， 世界上最大的艾滋病毒流行病与《和平协议》下被迫流离失所的遗留问题之间的相互作用 导致了大量的“内部移民”（在国内流动的人）， 在整个艾滋病毒护理过程中持续存在风险。大多数是迁移到城市中心的男子 找工作男性移民不仅面临与流动性相关的内在挑战， 还与影响参与的男性气质的内部和社会结构的变化作斗争， 在乎鉴于男性艾滋病毒感染者的死亡率比女性高两倍，迫切需要 确定能够有效地将感染艾滋病毒的移徙男子与护理联系起来并留住他们的干预措施。 目前的提案利用了哈佛医学院和 卫生经济学和流行病学研究办公室（HE 2 RO）的目标是解决独特的 南非国内男性艾滋病毒感染者面临的障碍。我们将使用顺序混合- 方法设计的具体目标是：（1）通过半结构化的深入探讨 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感染者（n=30）;（2）了解首选的艾滋病毒治疗和护理属性， 服务交付功能，并使用 离散选择实验（n=200）;（3）与参与者共同设计干预方案 和主要利益相关者，以促进联系和持续参与艾滋病毒护理使用设计思维。 该提案是对PA-19-050的回应，重点是“让男性参与艾滋病毒检测、预防和治疗”。 护理”，新的NIH重点是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。该R21通过产生证据来产生重大影响， 支持多层次的一揽子干预措施，以改善对艾滋病毒护理的接受和保留， 在艾滋病毒高流行率的城市环境中，南非男性移民的独特需求。这多- 专业团队拥有跨学科的专业知识，并在接触难以接触的人员方面有良好的记录 社区中的人口需要执行这项研究。

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.