Why Sub-Saharan African Patients Discontinue HIV Care

描述（由申请人提供）：撒哈拉以南非洲地区的艾滋病毒/艾滋病感染者通常服用超过90%的处方剂量的抗逆转录病毒治疗（ART）。然而，最近对33个非洲患者队列的保留数据进行的审查得出的结论是，两年后只有约60%的人继续接受艾滋病毒/艾滋病的医疗护理。对于争取长期治疗成功的非洲患者来说，坚持治疗是比坚持抗逆转录病毒治疗更大的问题。为了解决留存问题，我们必须了解人员流失的原因。我们提出了一项探索性的定性研究，研究撒哈拉以南非洲艾滋病护理人员流失的原因，这些原因是由相关个人直接报告的。这项研究将在乌干达西南部农村地区Mbarara地区转诊医院的HIV治疗和护理免疫抑制（ISS）诊所进行。使用已建立的患者跟踪系统，我们将找到、登记和访谈75名符合ART条件的HIV+患者，这些患者已登记接受护理但未能开始治疗，75名HIV+患者在开始ART后失去随访（总N=150）。还将与诊所的保健专业人员和工作人员进行面谈。结果数据将用于描述启动治疗失败（目标1）和随访失败（目标2）的原因。我们还将分析地描述跟踪系统在行动中，并使用结果来制定成功跟踪的策略（目标3）。最后，我们将通过记录随后返回护理的定位个体的数量来探索跟踪作为保留干预措施（目标4）。研究数据包括采访记录、现场笔记和包含返回护理数据的电子表格。写作和现场笔记将使用接地理论类别构建方法进行分析。研究参与者返回护理的比例将被计算并以百分比表示。这项调查是由一个专门为撒哈拉以南非洲开发的理论模型指导的，这是nimh之前资助的研究的一部分。将评估该模式与保留的相关性，并视需要作出调整，以便更合适。接下来的步骤包括将定性的“原因”类别作为未来定量研究的变量进行操作，并根据结果提出保留干预措施的想法。公共卫生相关性：该项目的目的是通过解决艾滋病毒护理耗损问题，促进撒哈拉以南非洲人接受艾滋病毒/艾滋病抗逆转录病毒疗法的长期临床成功。

DESCRIPTION (provided by applicant): Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART). However, a recent review of retention data from 33 African patient cohorts concluded that only about 60% remain in medical care for HIV/AIDS after two years. Retention in care is a bigger problem than ART adherence for African patients working toward long-term treatment success. To address the problem of retention, we must understand the reasons for attrition. We propose an exploratory, qualitative study of reasons for attrition from HIV care in sub-Saharan Africa as reported directly by the individuals involved. The study will be based at the Immune Suppression (ISS) Clinic for HIV treatment and care at Mbarara Regional Referral Hospital in rural southwest Uganda. Using an established system of tracking patients, we will locate, enroll and interview representative samples of 75 HIV+ individuals eligible for ART who have enrolled in care but failed to initiate therapy and 75 HIV+ individuals who have become lost to follow- up after beginning ART (Total N=150). Interviews with health professionals and staff at the clinic will also be carried out. The resulting data will be used to characterize reasons for failure to initiate therapy (Aim 1) and loss to follow-up (Aim 2). We will also analytically describe the tracking system in action and use the results to develop strategies for successful tracking (Aim 3). Finally, we will explore tracking as a retention intervention by documenting the number of located individuals who subsequently return to care (Aim 4). Study data consist of interview write-ups, field notes, and a spreadsheet containing data on return to care. Write-ups and field notes will be analyzed using grounded theory category construction methods. The proportion of study participants who return to care will be calculated and expressed as a percentage. This investigation is guided by a theoretical model of adherence developed specifically for sub-Saharan Africa as part of previous NIMH-funded research. The relevance of the model to retention will be assessed and adjustments made as necessary for a better fit. Next steps include operationalizing qualitative "reasons" categories as variables for future quantitative research and developing ideas for retention interventions suggested by the results. PUBLIC HEALTH RELEVANCE: The purpose of this project is to promote long-term clinical success for sub-Saharan Africans taking antiretroviral therapy for HIV/AIDS by addressing the problem of attrition from HIV care.