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.

项目摘要 如果有足够多的人开始并继续接受治疗，通用测试和治疗（UTT）可以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CD 4资格标准，2017年， 在诊断的同一天开始治疗患者。这些政策旨在增加抗逆转录病毒疗法 覆盖范围，并已被证明是有效的临床试验。然而，这些方法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 因此，减少病人的死亡对于指导南非下一阶段的艾滋病毒应对工作至关重要。 与国家卫生实验室服务（NHLS）合作，我们以前开发了一个国家艾滋病毒 通过删除南非公共部门艾滋病毒项目的完整实验室记录进行队列研究（>12 自2004年以来，超过4，000个设施的患者人数为1，000万人）。我们创建并验证的唯一患者标识符 能够在全国范围内对所有患者进行从临床表现到病毒抑制的纵向随访， 他们在哪里寻求照顾。该队列在跟踪转移到其他设施的患者方面是独一无二的 而不通知之前的诊所然而，它评估不包括一个国家的事件的能力有限。 实验室检查，如药物采集。 对于这项提案，我们将通过UTT时代更新NHLS国家艾滋病毒队列，并将其与来自 南非以设施为基础的抗逆转录病毒疗法监测和评价系统。我们将利用这一综合群体， 量化UTT级联每个阶段的损失，并评估UTT中的全系统保留和转移 时代然后，我们将评估两项UTT政策的影响-取消CD 4标准并实施相同的标准- 天ART -从临床表现到ART吸收、保留和病毒抑制的时间。 南非拥有世界上最大的艾滋病毒治疗项目。然而，直到最近，只有一半的艾滋病毒感染者 南非的人被病毒抑制了。UTT是南非自2010年以来最大的艾滋病毒政策转变。 ART于2004年推出。我们的研究是创新的，因为它提供了一个独特的国家，艾滋病毒的纵向视图， 南非的护理级联。我们的研究意义重大，因为我们将确定UTT在多大程度上 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，照亮干预的机会。