Exploring treatment burden and capacity for self care among patients with HIV/NCD multimorbidity in South Africa to inform interventions (EXTRA)

南非和其他撒哈拉以南非洲国家正在经历慢性病流行的双重负担：一种是传染病，最明显的是艾滋病毒，另一种是糖尿病和心血管疾病等迅速演变的非传染性疾病(NCD)流行。这导致了多种疾病(两种或两种以上同时发生的长期疾病或疾病)的模式与高收入国家常见的不同。值得注意的是，这些慢性病越来越多地出现在年轻人中，这对他们的家庭、经济生产力和医疗成本都有影响。目前，SA中多病患者的慢性医疗保健是分散和不协调的，没有考虑到患者在试图管理他们的病情时面临的越来越大的挑战。这项种子基金申请的主要目的是确定和了解艾滋病毒/非传染性疾病多发病患者及其照顾者所经历的疾病“工作量”。这些信息将被用来确保在南澳目前正在进行的旨在改善慢性护理服务的医疗改革倡议中充分考虑患者的观点。另一个目的是探索现有模型的相关性和适用性，这些模型解释了非传染性疾病治疗所涉及的工作量和患者处理它的能力。现有的模型是在高收入国家开发的，我们有兴趣使它们适应我们的环境，以便它们能够为南非以及可能在其他低收入和中等收入国家进行的未来研究和干预提供信息。我们将使用访谈和讨论小组进行这项研究。我们将采访一系列的患者和他们的照顾者，以探索他们如何经历自我管理的工作量以及他们处理这种工作量的能力。这将在西开普省的城市和农村环境中进行，因为例如，人们获得服务的机会可能不同。然后，我们将从相同的环境中招募医疗保健经理、医生、护士和社区卫生工作者进入‘任务小组’，讨论这些发现，并考虑它们对重新设计当地服务和干预措施意味着什么，这些服务和干预可能会减轻患者负担，增加他们的能力。我们还将举行进一步的会议，向省级和国家一级的政策和卫生管理人员介绍我们的研究结果，以影响卫生系统的改革。该项目将帮助我们为南非等低收入到中等收入的环境开发一个符合文化和背景的艾滋病毒/非传染性疾病工作量和能力模式。这项工作将有助于制定干预措施，然后可以在不同的环境中进行测试。

South Africa (SA) and other sub-Saharan African countries are experiencing a double burden of chronic disease epidemics: one of infectious disease, most notably HIV, and the other, a rapidly evolving epidemic of non- communicable diseases (NCDs) such as diabetes and cardiovascular disease. This is resulting in different patterns of multi-morbidities (two or more simultaneously occurring long term diseases or conditions) to those commonly seen in high income countries.Concerningly, these chronic diseases are being increasingly seen in younger people, which has implications for their families, economic productivity and healthcare costs.Currently, chronic healthcare for patients with multimorbidity in SA is fragmented and uncoordinated and does not take into account the increased challenges the patient faces in trying to manage their conditions. The primary aim of this Seed Funding Application is to identify and understand the illness 'workload' experienced by patients with HIV/NCD multimorbidity, as well as their caregivers. This information will be used to ensure that the patient perspective is fully considered in the healthcare reform initiatives that are currently underway in SA, which aim to improve chronic care services. A further aim is to explore the relevance and applicability of existing models that explain the workload involved in NCD treatment and patients' capacity to deal with it. Existing models have been developed in high income countries and we are interested to adapt them to our setting so that they can inform future research and interventions in South Africa and potentially in other low-and middle- income countries.We will use interviews and discussion groups for this study. We will interview a range of patients and their care givers to explore how they experience self-management workload and their capacity to deal with it. This will be in both an urban and rural setting in the Western Cape province as for example, peoples' access to services may differ. We will then recruit healthcare managers, doctors, nurses and community health workers from the same settings into 'task groups' to discuss these findings and consider what they mean for the redesign of local services and interventions that might reduce patient burden and increase their capacity. We will also hold further meetings to present our findings to policy and health managers at a provincial and national level to influence reforms in the health system.This project will help us develop a culturally and contextually appropriate model of HIV/NCD workload and capacity for a low -to- middle income setting such as SA. This work will contribute to development of interventions that can then be tested across different settings.