An implementation science approach to monitoring engagement in HIV care

项目摘要/摘要 职业目标：我的职业目标是成为一名领先的流行病学家，专注于提高对艾滋病毒的参与度 低收入和中等收入国家的护理(LMIC)。通过这次K99/R00提案，我希望将我的培训融合在一起 作为实施科学领域的流行病学家。有了这套技能，我计划建立一个专注于 关于实施干预措施，使感染艾滋病毒的妇女在围产期继续或重新参与艾滋病毒护理。 职业发展：我将专注于实施科学和专业发展方面的培训 该奖项的导师(K99)阶段。实施科学培训将集中在3个关键领域：1)核心 概念和理论2)利用技术实施更有效的艾滋病毒方案监测系统，以及 3)定性研究，为实施策略提供依据。职业发展培训将包括 课程作业，研讨会，建立我作为一个新兴的艾滋病毒研究人员的声誉，以及一个详细的计划 成功过渡到终身教职。研究项目：扩大抗逆转录病毒治疗 (ART)方案B+下的所有孕妇和哺乳期妇女有可能改变 艾滋病毒的流行。然而，为了实现备选方案B+的潜力，必须将妇女留在 艾滋病毒护理和那些失去后续行动(LTFU)的人必须重新接受护理。几乎没有重新接触的努力 艾滋病毒护理中的妇女是存在的。常规艾滋病毒项目监测是一种基于证据的干预措施，对 在备选方案B+下跟踪妇女参与艾滋病毒护理的情况，但其准确区分的能力有限 从那些已经转移到另一家艾滋病毒诊所的LTFU妇女。确定哪些女性为LTFU 对于及时重新参与艾滋病毒护理至关重要。拟议项目的目标是评估 利用技术加强艾滋病毒项目监测可能是一种实施战略，以准确识别 LTFU的女性。项目目标将通过以下四个具体目标实现：K99/1) 探讨使用技术进行艾滋病毒方案监测的态度，K99/2)以评估可行性和 改善艾滋病毒方案监测的3项实施战略的可接受性，R00/3)以评估增强的 艾滋病毒方案监测作为一项执行战略，R00/4)，以评估加强的成效 方案监测，提高艾滋病毒方案监测的准确性。良师益友：一位成就卓著、 多学科专家团队将在该奖项的头两年指导我，并提供持续的 当我过渡到独立的时候，我得到了指导。该指导团队包括：Mina Hosseiniour博士(主要 北卡罗来纳大学医学部导师；北卡罗来纳大学-马拉维项目)，Viian Go博士(卫生部共同导师 行为，北卡罗来纳大学)和威廉·米勒博士(俄亥俄州立大学流行病学系共同导师)和丽莎博士 Hightow-Weidman(北卡罗来纳大学医学部顾问)。未来方向：培训和研究 这份提案将为我提交一份使用技术增强艾滋病毒计划的R01申请做好准备 监测以确定哪些妇女是LTFU，并制定重新参与艾滋病毒护理干预的方法。

PROJECT SUMMARY/ABSTRACT Career Goal: My career goal is to become a leading epidemiologist focused on improving engagement in HIV care in low and middle income countries (LMIC). Through this K99/R00 proposal, I hope to merge my training as an epidemiologist with the field of implementation science. With this skill set, I plan to build a career focused on implementing interventions to retain or re-engage HIV-infected women in HIV care in the peripartum period. Career Development: I will focus on training in implementation science and professional development during the mentored (K99) phase of this award. Training in implementation science will focus in 3 key areas: 1) core concepts and theories 2) using technology to implement more effective HIV program monitoring systems, and 3) qualitative research to inform implementation strategies. Professional development training will include coursework, seminars, building my reputation as an emerging HIV researcher, and a detailed plan for a successful transition to a tenure-track position. Research Project: The scale-up of antiretroviral treatment (ART) to all pregnant and breastfeeding women under Option B+ has the potential to change the trajectory of the HIV epidemic. However, in order for the potential of Option B+ to be realized, women must be retained in HIV care and those who are lost to follow-up (LTFU) must be re-engaged in care. Few efforts to re-engage women in HIV care exist. Routine HIV program monitoring is an evidence-based intervention that is vital to track women's engagement in HIV care under Option B+, but is limited in its ability accurately distinguish women who are LTFU from those who have transferred to another HIV clinic. Identifying women who are LTFU is essential for timely re-engagement in HIV care. The goal of the proposed project is to evaluate whether enhancing HIV program monitoring with technology may be an implementation strategy to accurately identify women who are LTFU. The project goal will be achieved through the following four Specific Aims: K99/1) To explore attitudes towards using technology for HIV program monitoring, K99/2) To assess the feasibility and acceptability of 3 implementation strategies to improve HIV program monitoring, R00/3) To evaluate enhanced HIV program monitoring as an implementation strategy, R00/4) To evaluate the effectiveness of enhanced program monitoring to improve the accuracy of HIV program monitoring. Mentorship: A highly accomplished, multidisciplinary team of experts will mentor me in the first two years of this award and provide ongoing guidance as I transition to independence. This mentoring team includes: Dr. Mina Hosseinipour (Primary Mentor, Department of Medicine, UNC; UNC-Project Malawi), Dr. Vivian Go (Co-mentor, Department of Health Behavior, UNC) and Dr. William Miller (Co-mentor, Department of Epidemiology, Ohio State), and Dr. Lisa Hightow-Weidman (Adviser, Department of Medicine, UNC). Future Directions: The training and research in this proposal will prepare me to submit an R01 application that uses technology-enhanced HIV program monitoring to identify women who are LTFU and develops a re-engagement in HIV care intervention.