Overcoming Barriers to HIV/AIDS Care and ART Initiation

描述(由申请者提供)：该建议概述了一个五年的职业发展和研究计划，以培训候选人成为一名独立的流行病学调查员，专注于国际环境下的结果研究。候选人出色的学术表现和在艾滋病毒-1风险因素和传播方面的国际工作，包括预防干预的概括性，表明了他在流行病学方法和应用研究方面的专长。作为一名博士生，他领导了一项针对肯尼亚不和谐夫妇的大型前瞻性队列研究的流行病学设计和分析。在博士后研究期间，他调查了及时启动抗逆转录病毒疗法(ART)的障碍，并开发了风险因素分布对干预试验普适性的影响的数学模型，从而加强了这一研究经验。这一K01奖项将使候选人能够将这一背景整合到实施行为干预以促进艾滋病毒/艾滋病护理和治疗的新的调查路线中。候选人将得到专家导师的支持，提供指导，确保本项目的成功。丰富的制度环境将为他的职业发展提供支持。研究计划。在撒哈拉以南非洲的自愿咨询和检测(VCT)中心检测出HIV-1呈阳性的患者中，有一半未能与艾滋病毒/艾滋病护理联系起来。这突显了卫生系统中的一个严重缺陷，可以通过干预措施改善与护理的联系，从而减缓疾病进展、加速抗逆转录病毒治疗并改善健康结果。我们假设，实施科学方法将产生一揽子干预措施，以改善与护理和治疗的联系，这些措施将在非洲的各个地点迅速推广。我们将测试行为干预，并评估新的护理点(POC)CD4测试，以改善与护理的联系。具体目的是(1)确定基于VCT的CD4计数检测干预，单独或与同伴咨询相结合，是否改善了与艾滋病毒/艾滋病护理的联系；(2)评估干预对抗逆转录病毒治疗启动的影响；以及(3)确定与结果延迟返回的传统检测相比，使用新的POC检测快速返回CD4结果是否改善了与护理的联系。首先，我们将对患者、咨询师和健康提供者的护理障碍进行快速评估，以完善干预措施(基于VCT的CD4计数和同伴咨询)。然后，我们将从VCT中招募450名HIV阳性患者，并随机选择第三名接受标准咨询和转介，第三名在VCT接受CD4测试，结果在两周后通过电话返回，第三名接受相同的CD4测试和同伴咨询。我们将再招募150名参与者接受快速返回结果的POC CD4测试，并比较他们与两周后接受CD4结果的患者的护理比率之间的联系。这些联合调查将对适当的艾滋病毒/艾滋病护理的障碍有一个全面的了解，并产生新的干预措施，以便在应用环境中取得可衡量的结果。通过这一奖项，候选人将在执行科学方面获得新的专门知识，并将成为一名专注于在资源有限的情况下进行卫生干预的独立调查员。

DESCRIPTION (provided by applicant): This proposal outlines a five-year career development and research plan to train the candidate as an independent epidemiologic investigator focused on outcomes research in international settings. The candidate's strong academic performance and international work on HIV-1 risk factors and transmission, including generalizability of prevention interventions, demonstrates his expertise in epidemiologic methodology and applied research. As a doctoral candidate, he led the epidemiologic design and analysis of a large prospective cohort study of discordant couples in Kenya. This research experience was enhanced by a postdoctoral fellowship in which he investigated barriers to timely initiation of antiretroviral therapy (ART) and developed mathematical models for the impact of the distribution of risk factors on generalizability of intervention trials. This K01 award will enablethe candidate to integrate this background into a new line of investigation on the implementation of behavioral interventions to promote HIV/AIDS care and treatment. The candidate will be supported by expert mentors to provide guidance and ensure the success of this project. An enriching institutional environment will support his career development. RESEARCH PLAN. Half of patients testing positive for HIV-1 at voluntary counseling and testing (VCT) centers in Sub-Saharan Africa fail to link with HIV/AIDS care. This highlights a critical deficiency in the health system that can be addressed with interventions to improve linkage to care that will slow disease progression, accelerate ART initiation, and improve health outcomes. We hypothesize that an implementation science approach will produce a package of interventions to improve linkage to care and treatment that will be rapidly scalable across sites in Africa. We will test a behavioral intervention and evaluate new point-of-care (POC) CD4 testing to improve linkage to care. The specific aims are to (1) determine if a VCT-based intervention of CD4 count testing, alone or in combination with peer counseling, improves linkage to HIV/AIDS care; (2) assess the impact of the intervention on ART initiation; and (3) determine if rapid return of CD4 results using new POC testing improves linkage to care compared to conventional testing with delayed return of results. First, we will conduct a rapid assessment of barriers to care among patients, counselors, and health providers to refine the intervention (VCT-based CD4 counts and peer counseling). We will then recruit 450 HIV-positive individuals from VCTs and randomize a third to standard counseling and referral, a third to receive CD4 testing at the VCT with results return by phone after two weeks, and a third to receive the same CD4 testing combined with peer counseling. We will recruit an additional 150 participants to receive POC CD4 testing with rapid return of results and compare their linkage to care rates to those receiving CD4 results after two weeks. These combined investigations will create a comprehensive understanding of obstacles to appropriate HIV/AIDS care and result in new interventions to achieve measurable outcomes in applied settings. Through this award the candidate will gain new expertise in implementation science and will become an independent investigator focused on health interventions in resource-limited settings.