Evaluating UTT with a National HIV Cohort to Optimize South Africa's HIV Response (ENCORE)

通过国家 HIV 队列评估 UTT 以优化南非的 HIV 应对措施 (ENCORE)

• 批准号: 10397416
• 负责人: Jacob Bor
• 金额: $ 31.91万
• 依托单位: WITS HEALTH CONSORTIUM (PTY), LTD
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10397416
• 关键词: Africa; Boston; CD4 Lymphocyte Count; Caring; Clinic; Clinic Visits; Clinical; Clinical Trials; Collaborations; Complement; Country; Data; Databases; Diagnosis; Effectiveness; Eligibility Determination; Epidemic; Evaluation; Event; Future; HIV; Health; Interruption; Intervention; Laboratories; Link; Monitor; Patients; Pattern; Persons; Pharmaceutical Preparations; Phase; Policies; Population Surveillance; Predictive Value; Public Sector; Recording of previous events; Records; Research; Series; Services; South Africa; System; Testing; Time; Universities; Update; Viral; Viral Load result; antiretroviral therapy; base; care seeking; case finding; cohort; design; follow-up; individual patient; innovation; novel; programs; response; study population; treatment program; uptake

Project Summary Universal Test-and-Treat (UTT) could end the HIV epidemic if enough people start and stay on treatment. In 2016, South Africa eliminated CD4 eligibility criteria for antiretroviral therapy (ART) and, in 2017, the country moved to start patients on the same day as diagnosis. These policies were designed to increase ART coverage and have been shown to be effective in clinical trials. However, the real-world effectiveness of these UTT policies at scale is not known. Understanding the impact of UTT and at what stages of the UTT cascade patients are lost will be critical to guide the next phase of South Africa’s HIV response. In collaboration with the National Health Laboratory Service (NHLS), we previously developed a National HIV Cohort by de-duplicating the complete laboratory records of South Africa’s public sector HIV program (>12 million patients at >4000 facilities since 2004). The unique patient identifier that we created and validated enables longitudinal follow-up of all patients nationally from clinical presentation to viral suppression regardless of where they seek care. The cohort is unique in its ability to follow patients who transfer to other facilities without informing their prior clinic. However, it is limited in its ability to assess events that do not include a laboratory test, such as medication pickups. For this proposal, we will update the NHLS National HIV Cohort through the UTT era and link it with data from South Africa’s facility-based ART monitoring and evaluation system. We will use this integrated cohort to quantify losses at each stage of the UTT cascade and to assess systemwide retention and transfer in the UTT era. We will then evaluate the impact of two UTT policies – eliminating CD4 criteria and implementing same- day ART – on time from clinical presentation to ART uptake, retention, and viral suppression. South Africa has the largest HIV treatment program in the world. Yet until recently, just half of HIV-infected people in South Africa were virally-suppressed. UTT was South Africa’s largest HIV policy shift since the initial ART rollout in 2004. Our study is innovative because it offers a unique national, longitudinal view of the HIV care cascade in South Africa. Our study is significant because we will determine the extent to which UTT has increased ART coverage and viral suppression and we will identify where in the UTT cascade patients leave care, illuminating opportunities for intervention.

项目概要 如果有足够多的人开始并坚持接受治疗，普遍检测和治疗（UTT）可能会结束艾滋病毒的流行。在 2016 年，南非取消了抗逆转录病毒治疗 (ART) 的 CD4 资格标准，并于 2017 年 在诊断的同一天开始接受患者治疗。这些政策旨在提高 ART 覆盖范围广，并在临床试验中被证明是有效的。然而，这些措施在现实世界中的有效性 UTT 政策的规模尚不清楚。了解 UTT 的影响以及 UTT 级联的哪个阶段 患者流失对于指导南非下一阶段的艾滋病毒应对工作至关重要。 我们之前与国家卫生实验室服务 (NHLS) 合作，开发了国家艾滋病毒 通过对南非公共部门艾滋病毒项目的完整实验室记录进行重复删除（>12 自 2004 年以来，超过 4000 个机构已接待 100 万名患者）。我们创建并验证的唯一患者标识符 能够对全国所有患者进行纵向随访，从临床表现到病毒抑制，无论 他们寻求护理的地方。该队列的独特之处在于能够跟踪转移到其他机构的患者 没有通知他们之前的诊所。然而，它评估不包括事件的能力是有限的。 实验室测试，例如药物采集。 对于本提案，我们将通过 UTT 时代更新 NHLS 国家 HIV 队列，并将其与来自 南非基于设施的 ART 监测和评估系统。我们将利用这个综合队列来 量化 UTT 级联每个阶段的损失并评估 UTT 中的系统范围保留和转移 时代。然后我们将评估两项 UTT 政策的影响——消除 CD4 标准并实施相同的标准 日间 ART – 从临床表现到 ART 吸收、保留和病毒抑制的准时。 南非拥有世界上最大的艾滋病毒治疗计划。然而直到最近，只有一半的艾滋病毒感染者 南非人民的病毒受到抑制。 UTT 是南非自最初制定以来最大的艾滋病毒政策转变 2004 年推出 ART。我们的研究具有创新性，因为它提供了关于艾滋病毒的独特的全国性纵向观点 南非的护理级联。我们的研究很重要，因为我们将确定 UTT 的程度 增加 ART 覆盖率和病毒抑制，我们将确定 UTT 级联患者离开的位置 护理，阐明干预的机会。