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

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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.