Relationship Factors and Engagement in HIV Care in Malawi: A Dyadic Investigation

 描述（由申请人提供）：本K 01的目的是为候选人提供培训和指导，使其成为一名独立的行为科学家，拥有以夫妇为基础的方法的专业知识，以优化撒哈拉以南非洲地区艾滋病毒护理连续体（CC）的参与。对撒哈拉以南非洲艾滋病毒感染者的研究主要集中在结构和个人层面的障碍和促进因素上，导致对关系层面因素的理解薄弱。该K 01奖的一个核心组成部分是对艾滋病毒感染者夫妇参与艾滋病毒CC的二元方面进行研究。拟议的研究将设在马拉维，这是一个资源贫乏的国家，在撒哈拉以南非洲，11%的成年人感染艾滋病毒，估计每年有8,000名马拉维人死于艾滋病相关疾病。大多数新的艾滋病毒感染发生在婚姻或同居关系中。尽管马拉维的抗逆转录病毒疗法方案取得了成功，但大量有资格接受抗逆转录病毒疗法并已开始接受抗逆转录病毒疗法的艾滋病毒阳性者继续退出艾滋病毒防治中心。此外，随着越来越多的艾滋病毒阳性个体获得抗逆转录病毒治疗，而更健康，有越来越多的关注长期坚持抗逆转录病毒治疗。使用一个二元，混合方法的研究设计，研究的具体目标是：1）描述如何关系的背景下影响参与艾滋病毒CC在马拉维夫妇; 2）确定关系水平的障碍和促进者，影响参与艾滋病毒CC;以及3）制定初步干预措施，以优化马拉维夫妇参与艾滋病毒CC的情况。对于目标1，定性访谈将与25对夫妇（50人）进行，至少有一个合作伙伴谁是开始或已经在ART。对于目标2，定性结果将进行分析，以制定一项调查，为200 ART患者和他们的主要合作伙伴。该调查将收集有关关系动态和特征、治疗知识和信念、与艾滋病毒护理和治疗相关的背景因素以及参与艾滋病毒CC的措施（例如，还将从接受抗逆转录病毒治疗的应答者那里收集医疗记录数据和头发标本，以补充自我报告的参与护理的措施。对于目标3，将与社区成员和利益相关者进行20次半结构化访谈，并与夫妇进行4次焦点小组讨论，以了解制定以关系为重点的干预措施，以最佳利用艾滋病毒护理和治疗。通过这项研究计划，候选人将获得四个领域的实践培训：（1）人际关系理论，以了解健康行为;（2）收集和分析二元定性和定量数据的方法技能;（3）艾滋病毒/艾滋病的医疗保健和临床方面;和（4）行为干预设计和评估。一个由导师和科学顾问组成的跨学科小组将通过他们在基于夫妇的研究、二元数据分析、艾滋病毒/艾滋病的保健和医疗管理、艾滋病毒/艾滋病的行为干预以及马拉维当地知识方面的综合专业知识，支持培训和研究计划。

 DESCRIPTION (provided by applicant): The purpose of this K01 is to provide the candidate with the training and mentorship to become an independent behavioral scientist with expertise on couple-based approaches to optimize engagement in the HIV care continuum (CC) in sub-Saharan Africa. Research on the HIV CC in sub-Saharan Africa has largely focused on structural and individual-level barriers and facilitators, resulting in a weak understanding of factors at the relationship level. A central component of this K01 award is the conduct of research on dyadic aspects of engagement in the HIV CC among couples living with HIV. The proposed research will be situated in Malawi, a resource-poor country in SSA where 11% of adults are HIV-infected and an estimated 8,000 Malawians die each year from AIDS-related illness. The majority of new HIV infections occur within marriage or cohabitating unions. Despite the success of ART programs in Malawi, large numbers of HIV+ individuals who are eligible for ART and who have initiated ART continue to drop out of the HIV CC. Furthermore, as more HIV+ individuals access ART while healthier, there are growing concerns about long-term adherence to ART. Using a dyadic, mixed-methods study design, the specific aims of the research are: 1) to describe how the relationship context influences engagement in the HIV CC within Malawian couples; 2) to identify the relationship-level barriers and facilitators that affec engagement in the HIV CC; and, 3) to develop a preliminary intervention to optimize engagement in the HIV CC for Malawian couples. For Aim 1, qualitative interviews will be conducted with 25 couples (50 individuals) with at least one partner who is either starting or already on ART. For Aim 2, the qualitative findings will be analyzed to develop a survey for 200 ART patients and their primary partner. The survey will collect information on relationship dynamics and characteristics, treatment knowledge and beliefs, contextual factors related to HIV care and treatment, and measures of engagement in the HIV CC (e.g., attendance at clinic appointments, adherence to ART).Medical record data and hair specimens will also be collected from respondents on ART to supplement self-reported measures of engagement in care. For Aim 3, 20 semi-structured interviews with community members and stakeholders, and 4 focus group discussions with couples will be conducted to inform the development of a relationship-focused intervention targeting optimal use of HIV care and treatment. Through this research plan, the candidate will gain practical training in four areas: (1) interpersonal theory to understand health behavior; (2) methodological skills to collect and analyze dyadic qualitative and quantitative data; (3) healthcare and clinical aspects of HIV/AIDS; and (4) behavioral intervention design and evaluation. An interdisciplinary team of mentors and scientific advisors will support the training and research plan through their combined expertise in couples-based research, dyadic data analysis, healthcare and medical management of HIV/AIDS, behavioral interventions for HIV/AIDS, and local knowledge of the Malawi context.