Linkage & Retention: A Randomized Trial to Optimize HIV/TB Care in South Africa

描述（由申请人提供）：抗逆转录病毒治疗（ART）的益处只能通过及时的HIV诊断、成功的与护理联系以及开始治疗来实现。然而，在南非，只有一小部分新诊断的艾滋病毒感染者接受艾滋病毒治疗。在进行艾滋病毒检测之后但在开始抗逆转录病毒治疗之前，由于结核病的流行，这段时间的死亡率非常高，因此，在这段时间里，改善获得结核病筛查和艾滋病毒治疗的机会将大有裨益。尽管结核病是撒哈拉以南非洲地区艾滋病毒感染者死亡的主要原因，但南非只有不到三分之一的艾滋病毒感染者接受了结核病筛查。迫切需要努力实施和评估改善早期诊断以及与艾滋病毒和结核病护理联系的战略，并在卫生保健资源有限的背景下考虑这些战略。我们提出两个具体目标。第一个目标是进行一项随机对照试验，以确定卫生系统导航员干预在改善南非德班新诊断的艾滋病毒感染门诊患者与艾滋病毒和结核病治疗的联系方面的功效。使用Andersen的卫生服务利用模型作为理论框架，我们将提供一个卫生系统导航器来帮助患者识别和克服护理障碍，我们将检查影响护理联系的环境和患者层面因素的交集。第二个目标是评估这一干预措施在艾滋病毒筛查时促进与艾滋病毒和结核病治疗联系的成本和成本效益。2010年跨国立卫生研究院艾滋病毒相关研究计划优先评估与结核病和艾滋病毒护理整合相关的结果，包括生存、护理质量和成本，以及不同的检测、联系和护理保留方法对改善艾滋病毒疾病结果的影响。拟议的研究将通过在美国和艾滋病和结核病流行率最高的南非省份工作的医学、行为和成本效益专家之间的合作来解决其中的几个重要问题。研究结果将为南非和其他资源有限地区的艾滋病毒和结核病护理提供信息。

DESCRIPTION (provided by applicant): The benefits of antiretroviral therapy (ART) can only be achieved through timely HIV diagnosis, successful linkage to care, and treatment initiation. In South Africa, however, only a fraction of those newly diagnosed with HIV enter HIV care. The period after HIV testing but prior to ART initiation represents a time of very high mortality, fueled by the tuberculosis (TB) epidemic, and therefore a time when improving access to TB screening and HIV care would be of substantial benefit. Though TB is the leading cause death among those with HIV in sub-Saharan Africa, less than one-third of HIV-infected South Africans have been screened for TB. Efforts are urgently needed to implement and evaluate strategies that improve early diagnosis and linkage to HIV and TB care, and to consider such strategies in the context of constrained healthcare resources. We propose two specific aims. The first aim is to conduct a randomized controlled trial to establish the efficacy of a health system navigator intervention in improving linkage to HIV and TB care among newly diagnosed HIV-infected outpatients in Durban, South Africa. Using Andersen's model of health service utilization as a theoretical framework, we will provide a health system navigator to help patients identify and overcome barriers to care and we will examine the intersection of contextual and patient-level factors that affect linkage to care. The second aim is to evaluate the cost and cost-effectiveness of this intervention for promoting linkage to HIV and TB care at the time of HIV screening. The 2010 Trans-NIH Plan for HIV-related research prioritizes the assessment of outcomes related to TB and HIV care integration on survival, quality of care, and cost, as well as the impact of different approaches for testing, linkage, and retention in care in improving outcomes of HIV disease. The proposed study will address several of these important issues through collaboration among medical, behavioral and cost- effectiveness experts working in the US and the South African province with the highest prevalence of HIV and TB. The results will inform HIV and TB care in South Africa and in other resource-limited settings.