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

描述(由申请人提供)：撒哈拉以南非洲(SSA)扩大了获得抗逆转录病毒疗法(ART)的机会，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，但许多艾滋病毒携带者在获得护理方面受到延误，导致死亡率增加，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)在社区积极推广是一种被接受的检测人群的战略，与自愿咨询和检测(VCT)和其他检测方式相比，它在感染阶段更早地成功地识别和诊断了个人。然而，关于HBCT后与护理联系的数据有限，在资源有限的情况下，及时联系的个人、心理社会和结构性障碍在很大程度上是未知的。除非我们了解HBCT后获得护理的障碍和促进者，否则将不可能设计循证干预措施来促进与护理的联系，并优化HBCT和ART在特别行政区的个人和人群有效性。我的长期职业目标是成为一名独立研究人员，在医疗保健系统内成功开发和实施多层次干预措施，旨在解决在资源有限的情况下对艾滋病毒结果的个人、社会和结构性限制。为了实现这一目标，我建议在改善HBCT后与护理的联系方面获得专业知识，使用混合方法来开发和进行HBCT后心理社会干预的试点可行性研究。为了取得成功，我需要在以下方面进行进一步的培训：1)卫生服务研究；2)定性研究方法；3)卫生系统内的心理社会干预。这项工作将在肯尼亚埃尔多雷特的AMPATH(提供获得医疗保健的学术模型)联盟内进行，布朗大学与该联盟建立了长期和富有成效的伙伴关系，并有三个具体目标：1)进行回顾和多层次分析，以表征与保健的联系以及HBCT之后联系的个人和结构性决定因素；2)进行定性研究，以确定联系的心理和结构性促进因素和障碍 3)设计和试行心理社会干预措施，以改善与HBCT后护理的联系。为了实现这些目标，我将借鉴我的主要导师艾拉·威尔逊博士提出的培训和指导，他是旨在改善艾滋病毒临床结果的卫生服务研究和干预方面的专家，也是布朗大学卫生服务、政策和实践系的主席。我的导师团队还包括艾滋病毒护理交付和项目实施、定性研究以及社会和行为科学方面的专家。完成这些目标将为第四年提交的R01奠定基础，以设计和测试多层次干预措施，以解决在资源有限的情况下与艾滋病毒护理挂钩的个人、心理社会和结构限制。我之前的培训，在SSA进行相关研究的经验，以及在肯尼亚和布朗大学强大的指导团队，使我能够实现这些目标。

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.