Linkage to Care Following Home-Based Counseling and Testing in Western Kenya

描述（由申请人提供）：在撒哈拉以南非洲（SSA）扩大抗逆转录病毒治疗（ART）的可及性，导致艾滋病毒相关发病率和死亡率大幅下降。尽管扩大了获得艾滋病毒检测和抗逆转录病毒治疗的机会，但许多艾滋病毒感染者在获得护理方面被延误，导致死亡率上升，并给卫生保健系统带来压力。通过以家庭为基础的咨询和检测（HBCT）在社区积极开展外展活动是一种可接受的检测人群策略，与自愿咨询和检测（VCT）和其他检测方式相比，它已成功地在感染阶段早期识别和诊断个体。然而，关于HBCT后与护理联系的数据有限，在资源有限的环境中，及时联系的个人、社会心理和结构障碍在很大程度上是未知的。在我们了解HBCT后获得护理的障碍和促进因素之前，不可能设计以证据为基础的干预措施，以促进与护理的联系，并优化SSA中HBCT和ART的个人和人群有效性。我的长期职业目标是成为一名独立的研究人员，成功地在医疗保健系统中开发和实施多层次干预措施，旨在解决资源有限环境下艾滋病毒结果的个人、社会和结构限制。为了实现这一目标，我建议在本K01中获得改善HBCT后护理联系的专业知识，采用混合方法开发和开展HBCT后社会心理干预的试点可行性研究。为了取得成功，我需要进一步的培训：1)卫生服务研究；2)定性研究方法；3)卫生系统内的社会心理干预。这项工作将在肯尼亚埃尔多雷特建立的AMPATH（提供医疗保健学术模式）联盟内进行，布朗大学与该联盟建立了长期而富有成效的合作关系，并有三个具体目标：1)进行回顾性和多层次分析，以确定与医疗保健的联系以及HBCT后联系的个人和结构决定因素；2)进行定性研究，以确定连接的社会心理和结构促进因素和障碍

DESCRIPTION (provided by applicant): The expansion of access to antiretroviral therapies (ART) in sub-Saharan Africa (SSA) has resulted in dramatic reductions in HIV-related morbidity and mortality. Despite expanded access to both HIV testing and ART, many with HIV are delayed in accessing care causing increased mortality and strain on the health care system. Active outreach in communities through home-based counseling and testing (HBCT) is an accepted strategy for testing populations and has successfully identified and diagnosed individuals earlier in the stage of infection as compared to voluntary counseling and testing (VCT) and other testing modalities. Data on linkage to care following HBCT are limited, however, and the individual, psychosocial, and structural barriers to timely linkage are largely unknown in resource-limited settings. Until we understand the barriers and facilitators of accessing care following HBCT, it will not be possible to design evidence-based interventions to promote linkage to care and optimize the individual and population effectiveness of HBCT and ART in SSA. My long-term career goal is to become an independent researcher who successfully develops and implements multilevel interventions within healthcare systems designed to address the individual, social, and structural constraints on HIV outcomes in resource-limited settings. Toward this goal with this K01, I propose to gain expertise in improving linkage to care following HBCT, using a mixed-methods approach to develop and conduct a pilot feasibility study of a psychosocial intervention following HBCT. To be successful, I need further training in: 1) health services research; 2) qualitative research methods; and 3) psychosocial interventions within health systems. This work will take place within the well-established consortium AMPATH (Academic Model Providing Access to Healthcare) in Eldoret, Kenya, with which Brown University has had a long and productive partnership, and has three specific aims: 1) to conduct retrospective and multilevel analyses to characterize linkage to care and the individual and structural determinants of linkage following HBCT; 2) to perform a qualitative study to determine the psychosocial and structural facilitators and barriers to linking to care following HBCT; and 3) to design and pilot a psychosocial intervention to improve linkage to care following HBCT. To accomplish these aims, I will draw on the proposed training and guidance from my primary mentor, Dr. Ira Wilson, an expert in health services research and interventions designed to improve HIV clinical outcomes, and the Chair of the Department of Health Services, Policy & Practice at Brown University. My mentorship team also includes experts in HIV care delivery and program implementation, qualitative research, and the social and behavioral sciences. Completing these aims will provide the foundation for an R01 submitted during Year 4 to design and test a multilevel intervention to address the individual, psychosocial and structural constraints on linkage to HIV care in resource-limited settings. My prior training, experience conducting relevant research in SSA, and the strong mentoring team both in Kenya and at Brown strongly positions me to accomplish these aims.