Development and Testing of a Multi-Component Intervention to Support HIV Care Engagement among Patients Receiving Cancer Treatment in Zimbabwe

摘要 在津巴布韦，艾滋病毒感染者的癌症负担正在增加。持续参与艾滋病毒护理 对于降低艾滋病毒感染者的发病率和死亡率以及继续进行抗逆转录病毒治疗至关重要 通过癌症治疗是艾滋病毒感染者谁有癌症必不可少的。因为癌症和艾滋病的治疗 津巴布韦的途径是孤立的，试图获得癌症治疗的艾滋病毒感染者面临着独特的 在两个护理连续性方面的参与障碍。虽然艾滋病毒感染者和癌症患者的治疗指南， 低收入和中等收入环境建议整合癌症和艾滋病毒护理，但证据有限 如何在这些设置中成功地实现这一点的基础。在提供服务方面存在重大差距， 在津巴布韦，当艾滋病毒感染者同时被诊断出患有癌症时，需要持续的艾滋病毒护理。的目标 该项目旨在通过识别艾滋病毒护理参与的具体障碍来解决这一差距 艾滋病毒接受癌症治疗，并设计，完善和测试策略，以解决这些问题， 隔栏.在目标1中，我们将使用问卷调查和常规收集的临床数据来衡量对 随着时间的推移，艾滋病毒相关的护理癌症患者与艾滋病毒。在目标2A中，我们将使用混合方法 包括问卷调查和深入访谈，以量化和了解患者识别的障碍， 促进者在癌症治疗期间持续参与艾滋病毒护理连续体。在目标2B中，我们将 首先根据影响的普遍性和强度确定障碍的优先顺序，然后召集一个专家组， 艾滋病毒和癌症医疗保健和研究的利益相关者制定一套战略，以解决最高的 优先障碍。将使用快速周期改进一次实施和完善一项策略 最后一套2-3个经过改进的战略在目标3中结合起来并一起试行。在目标3中，我们 衡量患者和医院工作人员对一揽子战略的接受程度，作为我们的主要结果。 次要结果将包括艾滋病毒护理参与的障碍和促进者的吸收、经验，以及 艾滋病和癌症治疗的中断。我们将比较目标3参与者与目标1参与者的次要结局 参与者在一个准实验性的前后研究设计。这些目标构成了指导研究 这是候选人职业发展计划的一部分。在这项研究的同时，候选人将追求 在实施科学，定性方法，以及临床设计和评价方面的额外培训 护理干预措施，由美国经验丰富的艾滋病毒和癌症研究人员组成的模范团队提供支持。 国家和津巴布韦。拟议的工作将解决在为患有糖尿病的人提供临床护理方面的一个关键差距。 艾滋病毒和癌症在津巴布韦，并大大扩大蒙塔尼奥博士的方法专长，提供 培训、经验和数据，帮助她过渡到独立。

ABSTRACT In Zimbabwe, the burden of cancer among people with HIV is increasing. Consistent engagement in HIV care is critical to reducing morbidity and mortality among people with HIV in general, and continuation of ART through cancer treatment is essential for people with HIV who have cancer. Because the cancer and HIV care pathways in Zimbabwe are siloed, people with HIV who are attempting to access cancer treatment face unique barriers to engagement in both care continua. While guidelines for treatment of people with HIV and cancer in low- and middle-income settings recommend integration of cancer and HIV care, there is a limited evidence base for how to accomplish this successfully in these settings. There is an important gap in provision of continuous HIV care when people with HIV in Zimbabwe receive a concurrent diagnosis of cancer. The goal of this project is to address that gap by identifying barriers to HIV care engagement specific to people with HIV receiving cancer treatment, and devising, refining, and testing strategies to address those barriers. In Aim 1, we will use questionnaires and routinely collected clinical data to measure disruptions to HIV-related care over time among cancer patients with HIV. In Aim 2A, we will use a mixed-methods approach including questionnaires and in-depth interviews to quantify and contextualize patient-identified barriers and facilitators to consistent engagement in the HIV care continuum during cancer treatment. In Aim 2B, we will first prioritize barriers based on ubiquity and strength of impact, then convene a group of experts and key stakeholders in HIV and cancer healthcare and research to develop a set of strategies to address the highest priority barriers. Strategies will be implemented and refined one at a time using a rapid cycle improvement process, with a final set of 2-3 refined strategies combined and piloted together in Aim 3. In Aim 3, we will measure the acceptability of the package of strategies to patients and hospital staff as our primary outcome. Secondary outcomes will include uptake, experience of barriers and facilitators to HIV care engagement, and disruptions to HIV and cancer care. We will compare secondary outcomes in Aim 3 participants to Aim 1 participants in a quasi-experimental pre-post study design. These aims constitute the mentored research component of the candidate’s career development plan. In parallel with this research, the candidate will pursue additional training in implementation science, qualitative methods, and the design and evaluation of clinical care interventions, supported by an exemplary team of experienced HIV and cancer investigators in the United States and Zimbabwe. The proposed work will address a critical gap in provision of clinical care for people with HIV and cancer in Zimbabwe, and substantially expand Dr. Montaño’s methodological expertise, providing the training, experience and data for her transition to independence.