Enhancing linkage to HIV care for newly detected HIV-positive persons in Ukraine

项目摘要 乌克兰每年登记的艾滋病毒新病例超过20，000例，约占全国艾滋病毒感染者总数的40%。 与此同时，艾滋在新诊断的艾滋病毒阳性者中， 60%的人在同一日历年接受艾滋病毒护理。因此，在抗逆转录病毒时代，艾滋病 乌克兰的发病率和死亡率仍然很高，并不断上升。而专科患者 卫生保健设施（SHCF）（药物滥用，结核病和性病诊所），其中大多数患者 艾滋病毒危险行为被发现，获得免费的艾滋病毒检测，仍然迫切需要 加强对艾滋病毒感染者适当艾滋病毒护理的参与（联系和保留）。 存在一个加强与艾滋病毒护理联系的模式，并证明在2000年有效。 美国，但没有在乌克兰文化背景下进行测试。这项研究的目的是试点， 执行和评价旨在激励和管理最近艾滋病毒 乌克兰三个地区的SHCF确诊患者，他们将得到支持和激励， 开始并继续接受艾滋病医疗护理。我们将研究修改后的 抗逆转录病毒治疗可及性研究（MARTAS）干预，基于社会认知 理论，激励会议和护士个案管理，对艾滋病毒护理的参与， 最近发现的艾滋病毒阳性患者。 在我们的研究中，我们将利用现有的卫生保健基础设施和人力资源。这 该项目将在乌克兰的敖德萨、第聂伯罗彼得罗夫斯克和尼古拉耶夫地区实施， 在存在护士赞助制度的地方，在提供者发起的艾滋病毒检测中， PITC（PITC）是一种新的咨询方法。这项研究的具体目标是： 1)调整ARTAS干预方案，以便在最近确诊的艾滋病毒感染者中实施 积极的患者在乌克兰文化背景下使用形成性评估的结果（在- 与患者进行深入访谈，并与医疗保健提供者进行焦点小组讨论， 第聂伯罗彼得罗夫斯克）; 2）测试干预措施实施的可行性和可接受性， 尼古拉耶夫州的三个地点，有30名最近诊断为艾滋病毒阳性的患者;以及3） 在三个地区的9个研究中心进行前瞻性队列研究，评价干预有效性 （n=300例最近确诊的HIV患者）比较观察到的 干预前一年研究参与者中入组/保留HIV护理的人数 实施.我们假设，一个干预，涉及协调之间 a）由一名护士提供的联系协调， SHCF，B）结构化的激励会议和这些联系之间的进一步沟通 协调员（LC）和患者，以及c）LC和HIV护理提供者之间的沟通将 导致更多地参与艾滋病毒医疗护理。这项研究提出了一个重要的 艾滋病毒抗体阳性者未登记/延迟登记接受艾滋病毒护理的公共卫生威胁， 治疗我们的研究具有高度创新性，因为我们将扩大ARTAS的国际边界 实施研究乌克兰，使其适应当地的基础设施。

Project Summary Abstract Each year, more than 20,000 new HIV cases are registered in Ukraine, about 40% of them simultaneously with AIDS. Of the newly diagnosed HIV-positive individuals, only about 60% enroll in HIV care in the same calendar year. As a result, in the antiretroviral era, AIDS morbidity and mortality in Ukraine remain high and keep rising. While patients of specialized health care facilities (SHCFs) (substance abuse, TB, and STI clinics), where most patients with HIV risky behaviors are seen, have access to free HIV testing, there remains a critical need to improve engagement (linkage and retention) in appropriate HIV care for HIV-infected persons. A model of enhancing linkage to HIV care exists and proved to be effective over the U.S., but has not been tested in Ukrainian cultural context. The goal of this study is to pilot, implement and evaluate an intervention designed to motivate and manage recently HIV diagnosed patients of SHCFs in three regions of Ukraine, who will be supported and motivated to initiate and remain in HIV medical care. We will study the impact of the Modified Antiretroviral Treatment Access Study (MARTAS) intervention, based on the Social Cognitive Theory, motivational sessions and nurse case management, on the engagement in HIV care of recently detected HIV-positive patients. In our study we will use available health care infrastructure and human resources. This project will be implemented in Odesa, Dnipropetrovsk and Mykolaiv regions of Ukraine, at the SHCFs, where the system of patronage nurses exists, and provider-initiated HIV testing and counseling (PITC) approach has been implemented recently. The specific aims of the study are: 1) to adapt the ARTAS intervention protocol for implementation among recently diagnosed HIV positive patients in a Ukrainian cultural context using the results of formative assessment (in- depth interviews with patients and focus-group discussion with health care providers in Dnipropetrovsk); 2) to test the feasibility and acceptability of the intervention implementation at three sites of Mykolaiv region with 30 recently diagnosed HIV-positive patients; and 3) to evaluate the intervention effectiveness using prospective cohort study at 9 sites in three regions (n=300 recently HIV diagnosed patients) comparing the observed indicators of enrollment/retention in HIV care among study participants with the year prior to intervention implementation. We hypothesize that an intervention that involves coordination between specialized health care and HIV systems via a) linkage coordination delivered by a nurse of the SHCF, b) structured motivational sessions and further communication between these linkage coordinators (LCs) and patients, and c) communication between LC and HIV care provider will lead to increased engagement in HIV medical care. The proposed research addresses a significant public health threat of non-/late enrollment of HIV-positive individuals in HIV care and treatment. Our study is highly innovative, as we will extend the international borders of ARTAS implementation research to Ukraine, adapting it to the local infrastructure.