Why Sub-Saharan African Patients Discontinue HIV Care

描述（由申请人提供）：撒哈拉以南非洲的艾滋病毒/艾滋病感染者通常服用超过90%的抗逆转录病毒治疗（ART）处方剂量。然而，最近对33个非洲患者队列的保留数据进行的一项审查得出结论，两年后只有大约60%的艾滋病毒/艾滋病患者仍在接受医疗护理。对于致力于长期治疗成功的非洲患者来说，保持护理是一个比坚持ART更大的问题。要解决留住人才的问题，我们必须了解流失的原因。我们提出了一个探索性的，定性研究的原因，从艾滋病毒护理在撒哈拉以南非洲地区直接报告的个人参与。该研究将在乌干达西南部农村姆巴拉拉地区转诊医院的免疫抑制（ISS）诊所进行艾滋病毒治疗和护理。使用已建立的追踪患者的系统，我们将定位、招募和访谈符合ART条件的75名HIV+个体的代表性样本，这些HIV+个体已登记接受治疗但未能开始治疗，75名HIV+个体在开始ART后失访（总N=150）。还将与诊所的卫生专业人员和工作人员进行面谈。所得数据将用于表征未能启动治疗（目标1）和失访（目标2）的原因。我们还将分析性地描述跟踪系统，并使用结果来制定成功跟踪的策略（目标3）。最后，我们将探讨跟踪作为保留干预记录的个人谁随后返回护理（目标4）的数量。研究数据包括访谈记录、现场记录和包含返回护理数据的电子表格。写作和现场笔记将使用扎根理论类别构建方法进行分析。将计算返回护理的研究受试者比例，并表示为百分比。这项调查是由一个专门为撒哈拉以南非洲地区开发的理论模型，作为以前NIMH资助的研究的一部分。将评估模型与保留的相关性，并在必要时进行调整，以更好地拟合。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，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的流失问题，促进撒哈拉以南非洲接受艾滋病毒/艾滋病抗逆转录病毒疗法的人在临床上取得长期成功。

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.