Improving the HIV Care Cascade in Kenya through Implementation Science Training

摘要 华盛顿大学(UW)与肯尼亚的三所机构有30年的合作历史 (内罗毕大学、肯雅塔国家医院、肯尼亚医学研究所)，并与 肯尼亚卫生部，特别是国家艾滋病和性病控制计划(NASCOP)。建议数 培训赠款将侧重于肯雅塔国立医院(KNH)的能力建设，该医院是世界上最大的教学和医疗机构 肯尼亚的转诊医院，以改善艾滋病毒检测、与护理的联系、抗逆转录病毒的启动、依从性和 保留在护理中，这是一个被称为艾滋病毒护理级联的连续体。KNH和NASCOP的领导层 确定了在地方、国家和地区次区域解决这一护理级联中的“知识缺口” 撒哈拉非洲作为艾滋病毒研究的重中之重。为了满足这一需求，华盛顿大学在 与KNH和内罗毕大学合作，提议开展执行科学和卫生方面的培训 指标，两个研究交付挑战和实际结果的领域，以改善医疗保健 程序和底层系统。该项目将由华盛顿大学艾滋病中心主任凯里·法夸尔博士领导 自2003年起参加研究和培训计划(AITRP)，和John Kinuthia博士， 在KNH的研究。将提供两个相辅相成的长期培训课程：1)为期3年的每小时/博士课程 实施科学三明治方案，将在美国西雅图(一年级)和内罗毕举行， 肯尼亚(2-3年级)和2)为期1年的证书课程，其中将包括3个月的相关课程 华盛顿大学随后完成了健康指标研究所提供的另外两门UW课程和 通过远程学习进行评估(IHME)，并完成一个有指导的研究项目。参选候选人 培训将在KNH有长期职位，或在KNH有任命的卫生部，并可 来自不同的医学或公共卫生领域，包括护理和药学。除了长长的- 学期跟踪，我们将提供为期2周的短期培训，将达到更多的KNH和卫生部 专业人员(短期200人，长期16人)，将包括那些可能在 附属分散的公共设施。这种短期培训将建立更广泛的机构能力， 促进对关键研究概念和实践的认识，并确定未来长期研究的最佳候选者 学期训练。包括来自KNH和UW以及内罗毕大学学院的教职员工在内的团队 对于正在攻读博士学位的人来说，热带和传染病(UNID)将在正式的 指导计划。近期和长期结果将由国际货币基金组织进行外部监测 健康培训和教育中心(i-tech)在5年获奖期内。我们展望了 该计划将把KNH研究部门建设成一个强大的计划，以其在 实施科学培训和研究，并改善KNH和KNH的艾滋病毒护理级联 通过影响国家政策和产生高质量的、与地方相关的研究，超越其壁垒。

ABSTRACT The University of Washington (UW) has a 30 year history of collaboration with three Kenyan institutions (University of Nairobi, Kenyatta National Hospital, Kenya Medical Research Institute) and has strong ties to the Kenya Ministry of Health, particularly the National AIDS and STD Control Program (NASCOP). The proposed training grant will focus on building capacity at Kenyatta National Hospital (KNH), the largest teaching and referral hospital in Kenya, to improve HIV testing, linkage to care, antiretroviral initiation, adherence and retention in care, a continuum known as the HIV care cascade. Leadership at KNH and NASCOP has identified addressing "know-do gaps" in this care cascade locally, nationally and regionally in sub- Saharan Africa as a top HIV research priority. To meet this need, the University of Washington, in collaboration with KNH and the University of Nairobi, propose training in implementation science and health metrics, two fields studying delivery challenges and real-world outcomes in order to improve healthcare programs and underlying systems. The program will be led by Dr. Carey Farquhar, Director of the UW AIDS Research and Training Program (AITRP) since 2003, and Dr. John Kinuthia, Deputy Chair, Department of Research at KNH. Two complementary long-term training tracks will be offered: 1) a 3-year MPH/PhD sandwich program in implementation science which will take place in Seattle, USA (year 1) and in Nairobi, Kenya (years 2-3) and 2) a 1-year certificate program which will include 3 months of relevant coursework at the UW followed by completion of two additional UW courses offered by the Institute for Health Metrics and Evaluation (IHME) via distance learning, and completion of a mentored research project. Candidates for the training will have permanent positions at KNH, or at the Ministry of Health with appointments at KNH, and may be from different fields of medicine or public health, including nursing and pharmacy. In addition to the long- term tracks, we will offer short-term training lasting 2 weeks which will reach a larger number of KNH and MOH professional staff (200 individuals short-term vs. 16 long-term), and will include those who may be working in affiliated decentralized public facilities. This kind of short-term training will build broader institutional capacity, promote awareness of key research concepts and practices, and identify the best candidates for future long- term training. Teams including faculty from KNH and UW, as well as from the University of Nairobi Institute of Tropical and Infectious Diseases (UNITID) for those doing their PhD, will provide mentorship within a formal mentoring program. Immediate and long-term outcomes will be monitored externally by the International Training and Education Center for Health (I-TECH) during the 5-year award period. We envision the program will build the KNH research department into a robust program recognized for its expertise in implementation science training and research, and also improve the HIV care cascade at KNH and beyond its walls by influencing national policies and producing high-quality, locally relevant research.