Pathways to Engagement in HIV-Care for Newly-Diagnosed South Africans

随着全球努力扩大治疗计划和增加获得抗逆转录病毒治疗(ART)的机会， 在资源有限的国家，了解人们是如何与艾滋病毒联系在一起的至关重要的 关爱，因为许多人进入关爱的时间太晚，无法从艺术中受益。现在有很大的动力来促进 艾滋病毒检测作为增加早期护理登记的一种方式，但相对较少关注这一时期 就在一个人被确诊为HIV+之后。因为大多数对HIV+个体的研究都是 在那些已经登记参加CARE的人中进行，关于和 参加艾滋病毒初级保健和寻求护理的障碍--更普遍地是在新确诊的人中。 拟议的为期四年的研究将在南非的夸祖鲁-纳塔尔进行，旨在填补这一空白。我们的 目标是确定对艾滋病毒护理的登记和保留最显著的影响(与ART无关 资格)，如果得到解决，可以在#年优化新诊断的男女对服务的利用 在资源受限的情况下；与承诺采取干预措施的主要利益攸关方协作确定 进一步的开发和测试。具体目标是(1a)描述“注册时间”的累计 发病率曲线，估计艾滋病毒初级保健的登记比例，并确定 在多个层面上的影响--社会结构(污名、贫困、 性别不平等)、卫生系统(组织、政策、提供者)和个人(心理健康、社会健康 认知、与健康相关的行为)；(1b)探索关于披露和登记/保留的决策 在护理方面，以及污名、贫困、性别不平等和卫生系统因素如何塑造这些过程， 通过对队列参与者的子样本进行重复深入访谈；以及(1c)确定其他关键因素 问题，包括精神健康、生殖和其他与艾滋病毒有关的辅助服务的需要和使用 在新诊断的个体中。我们将进行一项前瞻性队列研究，跟踪550名新- 对女性和男性进行8个月的诊断，并在基线、4个月和8个月的随访中进行结构化评估- 对30个子样本重复深入访谈，并进行其他评估活动以进行评估 在卫生系统和社会结构层面上具有理论意义的变量，利用全球定位系统地图，以及 健康和社区服务清单、媒体跟踪和分析以及结构化顾问 评估。为了推动干预措施的发展，我们将审查和整合研究结果，并讨论 根据这些调查结果与公职人员、非政府组织(NGO)进行有希望的干预 通过交互式社区反馈，成员和工作人员、医疗保健提供者以及HIV+个人 会议；并举办能力建设干预发展讲习班，以加强各机构和 社区成员迅速制定有效、积极应对措施的能力。 1

With the global effort to scale-up treatment programs and increase access to antiretroviral therapy (ART) for HIV+ people in resource-constrained nations, it is vital to understand how people become linked to HIV primary care, as many are entering care too late to benefit from ART. There is now significant momentum to promote HIV testing as a way to increase early enrollment in care, but relatively little attention to address the period immediately after a person receives an HIV+ diagnosis. As most studies of HIV+ individuals have been conducted among those already enrolled in care, there is limited knowledge concerning facilitators of and impediments to enrolling in HIV primary care and care-seeking more generally among those newly-diagnosed. The proposed four-year study, to be conducted in Kwa-Zulu-Natal, South Africa, seeks to fill this gap. Our goals are to determine the most salient influences on enrollment and retention in HIV care (regardless of ART eligibility) that, if addressed, could optimize use of services among newly diagnosed men and women in resource-constrained settings; and to identify collaboratively with key stakeholders promising interventions for further development and testing. The Specific Aims are to (1a) describe the "time to enrollment" cumulative incidence curve, estimate the proportion that enrolls in HIV primary care, and determine the facilitators of and barriers to enrollment and retention in care at multiple levels of influence - social structural (stigma, poverty, gender inequalities), health systems (organization, policies, providers), and individual (mental health, social cognitions, health-related behaviors); (1b) Explore decision-making around disclosure and enrollment/retention in care, and how stigma, poverty, gender inequalities, and health system factors shape these processes, through repeat in-depth interviews with a sub-sample of cohort participants; and (1c) Identify additional critical issues, including need for and use of mental health, reproductive, and other HIV-related ancillary services among newly diagnosed individuals. We will conduct a prospective Cohort Study following 550 newly- diagnosed women and men for eight months with structured assessments at Baseline, 4- and 8-month follow- up, repeat In-Depth Interviews with a subsample of 30, and additional assessment activities to evaluate variables of theoretical interest at the health system and social structural levels, utilizing GPS mapping, an Inventory of Health and Community Services, Media Tracking and Analysis, and structured Counselor Assessments. To advance intervention development, we will review and integrate study findings and discuss promising interventions based on these findings with public officials, non-governmental organization (NGO) members and staff, health care providers, and HIV+ individuals through Interactive Community Feedback sessions; and conduct capacity-building Intervention Development Workshops to enhance agencies' and community members' capacity to rapidly formulate effective, pro-active responses. 1