Why Sub-Saharan African Patients Discontinue HIV Care

为什么撒哈拉以南非洲患者停止艾滋病毒护理

• 批准号: 7685004
• 负责人: NORMA C WARE
• 金额: $ 26.07万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7685004
• 关键词: AIDS/HIV problem; Address; Adherence; Africa South of the Sahara; African; Appointment; Appointments and Schedules; Back; Caring; Categories; Cessation of life; Clinic; Clinical; Coin; Data; Dose; Enrollment; Eye; Failure; Family; Funding; Future; HIV; Health; Health Professional; Health system; Hospital Referrals; Immune; Individual; Intake; Interruption; Intervention; Interview; Investigation; Life; Life Expectancy; Medical; Methods; Modeling; Participant; Patients; Process; Reporting; Research; Resistance development; Risk; Rural; Sampling; Screening procedure; System; Theoretical model; Treatment Protocols; Uganda; Visit; Work; Writing; antiretroviral therapy; base; cohort; follow-up; improved; public health relevance; stem; success; theories; therapy adherence

DESCRIPTION (provided by applicant): Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART). However, a recent review of retention data from 33 African patient cohorts concluded that only about 60% remain in medical care for HIV/AIDS after two years. Retention in care is a bigger problem than ART adherence for African patients working toward long-term treatment success. To address the problem of retention, we must understand the reasons for attrition. We propose an exploratory, qualitative study of reasons for attrition from HIV care in sub-Saharan Africa as reported directly by the individuals involved. The study will be based at the Immune Suppression (ISS) Clinic for HIV treatment and care at Mbarara Regional Referral Hospital in rural southwest Uganda. Using an established system of tracking patients, we will locate, enroll and interview representative samples of 75 HIV+ individuals eligible for ART who have enrolled in care but failed to initiate therapy and 75 HIV+ individuals who have become lost to follow- up after beginning ART (Total N=150). Interviews with health professionals and staff at the clinic will also be carried out. The resulting data will be used to characterize reasons for failure to initiate therapy (Aim 1) and loss to follow-up (Aim 2). We will also analytically describe the tracking system in action and use the results to develop strategies for successful tracking (Aim 3). Finally, we will explore tracking as a retention intervention by documenting the number of located individuals who subsequently return to care (Aim 4). Study data consist of interview write-ups, field notes, and a spreadsheet containing data on return to care. Write-ups and field notes will be analyzed using grounded theory category construction methods. The proportion of study participants who return to care will be calculated and expressed as a percentage. This investigation is guided by a theoretical model of adherence developed specifically for sub-Saharan Africa as part of previous NIMH-funded research. The relevance of the model to retention will be assessed and adjustments made as necessary for a better fit. Next steps include operationalizing qualitative "reasons" categories as variables for future quantitative research and developing ideas for retention interventions suggested by the results. PUBLIC HEALTH RELEVANCE: The purpose of this project is to promote long-term clinical success for sub-Saharan Africans taking antiretroviral therapy for HIV/AIDS by addressing the problem of attrition from HIV care.

描述（由申请人提供）：撒哈拉以南非洲地区的艾滋病毒/艾滋病患者通常接受超过 90% 的抗逆转录病毒治疗 (ART) 处方剂量。然而，最近对 33 个非洲患者队列的保留数据进行的审查得出的结论是，两年后，只有约 60% 的患者仍在接受艾滋病毒/艾滋病的医疗护理。对于致力于长期治疗成功的非洲患者来说，继续接受护理是比 ART 依从性更大的问题。为了解决保留问题，我们必须了解流失的原因。我们建议对撒哈拉以南非洲地区艾滋病毒护理人员流失的原因进行一项探索性定性研究，由相关个人直接报告。该研究将在乌干达西南部乡村姆巴拉拉地区转诊医院的免疫抑制（ISS）诊所进行艾滋病毒治疗和护理。利用已建立的患者跟踪系统，我们将找到、登记和访谈 75 名符合 ART 资格且已参加护理但未能开始治疗的 HIV+ 个体以及 75 名在开始 ART 后失访的 HIV+ 个体的代表性样本（总数 N=150）。还将对诊所的卫生专业人员和工作人员进行采访。所得数据将用于描述未能开始治疗（目标 1）和失访（目标 2）的原因。我们还将分析描述正在运行的跟踪系统，并使用结果来制定成功跟踪的策略（目标 3）。最后，我们将通过记录随后返回护理的已定位人员的数量，探索将跟踪作为保留干预措施（目标 4）。研究数据包括访谈记录、现场笔记和包含返回护理数据的电子表格。将使用扎根理论类别构建方法来分析文章和现场笔记。将计算返回护理的研究参与者的比例并以百分比表示。这项调查以专门为撒哈拉以南非洲地区开发的遵守理论模型为指导，该模型是 NIMH 资助的先前研究的一部分。将评估模型与保留的相关性，并根据需要进行调整以更好地适合。下一步包括将定性“原因”类别作为未来定量研究的变量，并制定结果所建议的保留干预措施的想法。公共卫生相关性：该项目的目的是通过解决艾滋病毒护理人员流失问题，促进撒哈拉以南非洲人接受抗逆转录病毒治疗艾滋病毒/艾滋病的长期临床成功。