Development and Testing of a Multi-Component Intervention to Support HIV Care Engagement among Patients Receiving Cancer Treatment in Zimbabwe

摘要 在津巴布韦，艾滋病毒携带者的癌症负担正在增加。始终如一地参与艾滋病毒护理 对于总体上降低艾滋病毒感染者的发病率和死亡率以及继续抗逆转录病毒疗法至关重要。 通过癌症治疗对于患有癌症的艾滋病毒携带者来说是必不可少的。因为癌症和艾滋病毒的护理 津巴布韦的道路是孤立的，试图获得癌症治疗的艾滋病毒携带者面临着独特的 在这两个护理连续体中的参与障碍。虽然艾滋病毒感染者和癌症患者的治疗指南 低收入和中等收入人群建议将癌症和艾滋病毒护理结合起来，证据有限 为如何在这些设置中成功完成此任务奠定了基础。在供应方面有一个重要的缺口 当津巴布韦的艾滋病毒携带者同时被诊断为癌症时，持续的艾滋病毒护理。的目标是 该项目旨在通过确定特定人群参与艾滋病毒护理的障碍来解决这一差距 HIV接受癌症治疗，并设计、完善和测试策略来解决这些问题 障碍。在目标1中，我们将使用问卷和常规收集的临床数据来衡量中断 随着时间的推移，对艾滋病毒携带者的癌症患者进行艾滋病毒相关护理。在目标2A中，我们将使用混合方法方法 包括问卷调查和深度访谈，以量化患者识别的障碍并了解其背景 促进者在癌症治疗期间持续参与艾滋病毒护理。在目标2B中，我们将 首先根据普及性和影响强度确定障碍的优先顺序，然后召集一组专家和关键 艾滋病毒和癌症医疗保健和研究的利益攸关方制定一套战略，以解决最高 优先障碍。战略将通过快速的周期改进逐一实施和完善 流程，最后一套2-3个精细化策略组合在一起并在目标3中试行。在目标3中，我们将 作为我们的主要结果，衡量一整套策略对患者和医院工作人员的可接受性。 次要结果将包括对艾滋病毒护理参与的接受、障碍和促进者的经验，以及 中断艾滋病毒和癌症护理。我们将比较目标3参与者和目标1参与者的次要结果 受试者采用准实验前置研究设计。这些目标构成了指导性研究 候选人职业发展计划的组成部分。在这项研究的同时，候选人将继续 在实施科学、定性方法以及临床设计和评估方面的其他培训 护理干预，由美国经验丰富的艾滋病毒和癌症调查人员组成的模范团队提供支持 美国和津巴布韦。拟议的工作将解决为患有癌症的人提供临床护理方面的一个严重缺口 在津巴布韦，艾滋病毒和癌症，并大大扩展蒙塔尼奥博士的方法学专长，提供 培训，经验和数据，为她过渡到独立。

ABSTRACT In Zimbabwe, the burden of cancer among people with HIV is increasing. Consistent engagement in HIV care is critical to reducing morbidity and mortality among people with HIV in general, and continuation of ART through cancer treatment is essential for people with HIV who have cancer. Because the cancer and HIV care pathways in Zimbabwe are siloed, people with HIV who are attempting to access cancer treatment face unique barriers to engagement in both care continua. While guidelines for treatment of people with HIV and cancer in low- and middle-income settings recommend integration of cancer and HIV care, there is a limited evidence base for how to accomplish this successfully in these settings. There is an important gap in provision of continuous HIV care when people with HIV in Zimbabwe receive a concurrent diagnosis of cancer. The goal of this project is to address that gap by identifying barriers to HIV care engagement specific to people with HIV receiving cancer treatment, and devising, refining, and testing strategies to address those barriers. In Aim 1, we will use questionnaires and routinely collected clinical data to measure disruptions to HIV-related care over time among cancer patients with HIV. In Aim 2A, we will use a mixed-methods approach including questionnaires and in-depth interviews to quantify and contextualize patient-identified barriers and facilitators to consistent engagement in the HIV care continuum during cancer treatment. In Aim 2B, we will first prioritize barriers based on ubiquity and strength of impact, then convene a group of experts and key stakeholders in HIV and cancer healthcare and research to develop a set of strategies to address the highest priority barriers. Strategies will be implemented and refined one at a time using a rapid cycle improvement process, with a final set of 2-3 refined strategies combined and piloted together in Aim 3. In Aim 3, we will measure the acceptability of the package of strategies to patients and hospital staff as our primary outcome. Secondary outcomes will include uptake, experience of barriers and facilitators to HIV care engagement, and disruptions to HIV and cancer care. We will compare secondary outcomes in Aim 3 participants to Aim 1 participants in a quasi-experimental pre-post study design. These aims constitute the mentored research component of the candidate’s career development plan. In parallel with this research, the candidate will pursue additional training in implementation science, qualitative methods, and the design and evaluation of clinical care interventions, supported by an exemplary team of experienced HIV and cancer investigators in the United States and Zimbabwe. The proposed work will address a critical gap in provision of clinical care for people with HIV and cancer in Zimbabwe, and substantially expand Dr. Montaño’s methodological expertise, providing the training, experience and data for her transition to independence.