Using Information to Align Services and Link and Retain Men in the HIV Cascade

 描述(申请人提供)：在南非，世界上艾滋病毒感染负担最重的国家，男性要么无法接触到艾滋病毒检测、治疗和护理的“级联”，要么很早就退出了，其比率比女性高得多。将男性更早地与护理联系起来，并让他们保持更长时间的依附，不仅会改善他们自己的健康，还会直接转化为他们的伴侣的一系列更好的健康结果， 家庭和社区。男性退出艾滋病毒链式反应的原因有很多，但有两个关键因素：1)卫生系统内与艾滋病毒相关的各种服务支离破碎，2)卫生系统与社区支持艾滋病毒感染者或试图避免感染艾滋病毒的人的努力之间存在持续差距。很少有干预措施存在，特别是在 男人们，来解决这两个关键差距。这一项目--使用信息统一服务，并将男性与艾滋病毒串联或“i-Alarm”联系在一起--试图对这一未得到充分认识但紧迫的需求“发出警报”，并开发利用卫生信息的方法，以便更有效地协调卫生系统和社区服务提供者的工作。其具体目标是：1)了解现有男性艾滋病毒级联的表现，并确定影响男性在这一级联中流动的规模和速度的因素；2)开发健康信息管理(HIM)干预措施，将诊所和社区提供者聚集在一起，以改进这一级联的绩效；3)试行这一干预措施，并评估其以何种方式a)改善诊所和社区服务之间的沟通和协调；b)导致服务设计和提供的变化；c)改善男子与艾滋病毒护理的联系和保持。为了实现目标1，我们将对开普敦一个卫生分区的男子的当地艾滋病毒级联进行混合方法研究，使用定性形成研究和具有回顾和前瞻性队列的队列研究。为了实现目标2，我们将咨询健康信息和管理专家，以制定HIM干预措施，并与开普敦社区中已经合作的诊所和社区提供者合作，建立“男性联系和保留在护理中的工作组”(LRTT)。在目标3中，我们将支持LRTT试点HIM干预，并对这一试点进行评估，使用混合方法对试点进行过程评估，并使用从目标1开始的预期队列研究的结果进行评估。该项目具有创新性，不仅将艾滋病毒级联作为总体概念框架，而且将其具体实施为一种干预措施，将诊所和社区利益攸关方聚集在一起，催化协调他们将男性联系在一起并留住男性护理的努力。我们预计i-Alarm将产生一个工作模式--可扩展并可转移到其他健康问题和环境中--用于诊所和社区利益相关者之间的健康信息管理如何产生创新和可持续的反应，以满足关键的公共卫生需求。

 DESCRIPTION (provided by applicant): In South Africa, the country with the highest burden of HIV infection in the world, men either fail to access or drop out early from the 'cascade' of HIV testing, treatment and care at considerably higher rates than women. Linking men to care earlier, and keeping them retained and adherent for longer, will improve not only their own health, but will also directly translate into a range of better health outcomes for their partners, families and communities. There are many reasons men drop out of the HIV cascade but two critical factors are 1) the fragmentation within the health system across its various HIV-related services, and 2) a persistent gap between health system- and community-based efforts to support those living with-or trying to avoid-HIV infection. Few interventions exist, especially for men, to address these two critical gaps. This project-Using Information to Align Services and Link and Retain Men in the HIV Cascade-or 'i-ALARM', seeks to 'raise the alarm' about this under-recognized but urgent need, and to develop ways of using health information to more effectively coordinate the work of health system and community service providers. Its specific aims are 1) to understand the performance of the existing HIV cascade for men, and determine the factors affecting the scale and pace of men's movement through this cascade, 2) to develop a health information management (HIM) intervention that brings clinic and community-based providers together to improve the performance of this cascade, and 3) to pilot this intervention and evaluate in what ways it a) improves communication and coordination among clinic and community services, b) leads to changes in service design and delivery, and c) improves men's linkage to and retention in HIV care. To achieve Aim 1, we will conduct a mixed methods study of the local HIV cascade for men in a Cape Town health sub-district using qualitative formative research and a cohort study with retrospective and prospective cohorts. To achieve Aim 2, we will consult with health information and management experts to develop the HIM intervention and work with clinic and community providers already working together in a Cape Town community to establish a 'Men's Linkage and Retention in Care Task Team' (LRTT). In Aim 3, we will support the LRTT in piloting the HIM intervention and conduct an evaluation of this pilot, using both a mixed methods process evaluation of the pilot and an outcomes evaluation using the findings from the prospective cohort study begun in Aim 1. This project is innovative for not only using the HIV cascade as an overarching conceptual framework, but for operationalizing it concretely in an intervention that brings clinic and community stakeholders together to catalyze coordination of their efforts to link and retain men in care. We expect i-ALARM will produce a working model-up-scalable and transferable to other health problems and settings-for how health information management between clinic and community stakeholders can produce innovative and sustainable responses to critical public health needs.