Psychosocial Barriers to Engagement in Care in Young South African Women with HIV

描述(由申请人提供)：对艾滋病毒感染者及早开始抗逆转录病毒治疗(ART)具有巨大的好处，包括降低发病率和死亡率，并减少二次传播。在南非，抗逆转录病毒治疗方案早期出现的高死亡率通常是由于护理开始时的晚期疾病所致。南非政府自2010年以来一直将广泛的艾滋病毒检测列为优先事项，但除非艾滋病毒感染者及时进行护理，否则这项运动不会改善临床和预防结果。在撒哈拉以南非洲，青少年妇女的艾滋病毒感染率极高。在这一人群中治疗和预防艾滋病毒对减轻疾病负担至关重要。然而，在感染艾滋病毒的青少年中，对参与护理的挑战，例如感觉到的耻辱和不遵守护理和治疗，可能会放大。在南非的成年人中，抗逆转录病毒治疗前失去护理的比例高达50%，在青少年中可能更高。为了改善年轻妇女艾滋病毒检测和治疗之间的联系，必须了解可能妨碍获得临床服务的可修改的障碍。心理社会和行为因素影响艾滋病毒感染者对护理和治疗的坚持，可能对青少年特别重要，因为他们的心理、社会和身体环境正在发生变化。感染艾滋病毒的青少年患心理健康疾病和行为障碍的风险增加，但这些因素尚未在参与护理的背景下进行研究。这项Kirschstein-NRSA个人奖学金(F30)的目的是评估南非农村感染艾滋病毒的青春期妇女参与护理的可修改的心理社会障碍。这项拟议的研究将在新诊断的感染艾滋病毒的年轻女性中进行为期一年的前瞻性队列设计，纳入正在进行的随机对照试验，具体目的如下：1)评估艾滋病毒感染状况的披露与诊断后一年多参与护理之间的关系；2)确定基线和事件抑郁和焦虑障碍与护理投入之间的关系；以及3)确定对新诊断的艾滋病毒的应对反应与护理投入之间的关系。这项研究将首次评估可能影响撒哈拉以南非洲感染艾滋病毒的青春期妇女卫生保健利用的可改变的个人因素。拟议研究的结果将为未来的干预措施提供信息，以改善对这一脆弱和高危人群的具体护理。这项F30奖学金将为申请者提供特殊的综合培训 流行病学、艾滋病毒、传染病和心理健康，以促进她作为医生-流行病学家的职业目标，在资源稀缺的环境下研究艾滋病毒感染和性传播疾病。 公共卫生相关性：艾滋病毒感染者的早期参与护理是成功的艾滋病毒治疗和预防方案的关键组成部分，但多达50%的艾滋病毒感染者直到临床患病才寻求护理。这项拟议的研究将首次评估感染艾滋病毒的年轻南非妇女参与护理的可改变的心理社会障碍，这是一个感染艾滋病毒风险特别高的群体。这项工作的结果将为今后的干预措施提供信息，以改善专门针对这一弱势群体的护理工作。

DESCRIPTION (provided by applicant): Early initiation of anti-retroviral treatment (ART) for HIV-infected persons has enormous benefits, including decreased morbidity and mortality, and reduced secondary transmission. In South Africa, the high mortality rates seen early in ART programs are often due to advanced disease stage at care initiation. The South African government has prioritized widespread HIV testing since 2010 but this campaign will not improve clinical and preventive outcomes unless HIV-infected persons engage in care in a timely manner. In sub-Saharan Africa, the prevalence of HIV infection is extremely high in adolescent women. Treatment and prevention of HIV in this population is critical to reduce the burden of disease. However, challenges to engagement in care, such as perceived stigma and non-adherence to care and treatment, are likely magnified in HIV-infected adolescents. In adults in South Africa, pre-ART loss to care is as high as 50%, and may be even greater in adolescents. To improve the link between HIV testing and treatment among young women, modifiable barriers that might preclude accessing of clinical services must be understood. Psychosocial and behavioral factors affect adherence to care and treatment among HIV-infected persons, and may be especially important for adolescents because their psychological, social, and physical contexts are undergoing change. HIV-infected adolescents are at increased risk of mental health illnesses and behavioral disorders, but these factors have not been studied in the context of engagement in care. The objective of this Kirschstein-NRSA individual fellowship (F30) is to assess modifiable psychosocial barriers to engagement in care among HIV- infected adolescent women in rural South Africa. The proposed study will be a one-year prospective cohort design among newly diagnosed HIV-infected young women incorporated into an ongoing randomized controlled trial, with the following specific aims: 1) To evaluate the relationship between disclosure of HIV infection status and engagement in care over 1 year following diagnosis; 2) To determine the relationship between baseline and incident depression and anxiety disorders and engagement in care; and 3) To determine the relationship between coping responses to newly diagnosed HIV and engagement in care. This study will be the first to evaluate modifiable personal factors that may affect health-care utilization among HIV-infected adolescent women in sub-Saharan Africa. Findings from the proposed research will inform future interventions to improve engagement in care specific to this vulnerable and high-risk population. This F30 fellowship will provide the applicant with exceptional integrated training in epidemiology, HIV, infectious diseases, and mental health to further her career goals as a physician-epidemiologist studying HIV infection and sexually transmitted diseases in resource-scarce settings. PUBLIC HEALTH RELEVANCE: Early engagement in care among HIV-infected persons is a critical component of successful HIV treatment and prevention programs, yet up to 50% of HIV-infected South Africans do not seek care until they are clinically ill. The proposed study will be the first to assess modifiable psychosocial barriers to engagement in care among HIV-infected young South African women, a group at particularly high risk for HIV infection. Results from this work will inform future interventions to improve engagement in care that are specifically targeted to this vulnerable population.