Leaving no one behind: Identifying approaches to improving HIV treatment outcomes among older Ugandans

不让任何人掉队：确定改善乌干达老年人艾滋病毒治疗结果的方法

• 批准号: MR/N027515/1
• 负责人: Janet Seeley
• 金额: $ 19.18万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FN027515%2F1
• 关键词: Leaving; no; behind; Identifying; approaches

The number of people living with HIV in sub-Saharan Africa (SSA) is increasing, as people live longer due to increased access to treatment. Specifically the number of people living with HIV who are aged 50 years or older is predicted to increase from 3.1 million people in 2011 to 9.1 million in 2040. Facilitating older people's access to anti-retroviral therapy (ART) and enabling their ability to adhere to their treatment is key for their own health, and following a 'treatment as prevention' model it is also key to preventing the spread of HIV into the wider population.Older adults have been largely neglected by the prevention community, because the focus has been on reproductive health, mother-to-child transmission, and younger populations where known HIV incidence is high. There is also an ageist driven myth that older adults are not sexually active. Adults remain sexually active well into old age, with the cessation of sexual activity typically resulting from physical health problems and/or the unavailability of a sexual partner which is particularly the case among older women. Studies of HIV-positive older adults in the U.S. find they too remain sexually active, but upwards of 40% do not use condoms regularly; similar results are emerging from research in Africa. Access to ART can protect their own health and reduce their infectivity. Few studies have examined the barriers for older persons to access treatment for HIV, and to adhere to the treatment, and interventions to improve ART access and adherence have not specifically focused on older adults. This project in Uganda will contribute evidence to address a gap in knowledge on older persons' barriers to ART access and adherence in SSA.It is not clear whether barriers and facilitators to ART access and adherence would be the same for older populations as younger populations, or if social interventions that have worked well for other populations would sufficiently address older adults' needs. Older adults' barriers to other health care services in SSA include high rates of poverty limiting money for transport and care; multi-morbidity; ageism; and little understanding among health providers of older persons' needs. Their wellbeing is further implicated by social isolation and HIV-related stigma. This project will be the first to develop a tailored multi-pronged social intervention that identifies and addresses older Africans' barriers to ART access and adherence by addressing needs at the individual, community and health system levels.In this project, we will develop and refine a multi-pronged social intervention to improve access, adherence and wellbeing among older Ugandans. The specific aims of the project are to: (1) Use interviews with older adults, community leaders and health care workers to identify barriers and facilitators to older adults' ART access and adherence. (2a) Develop an intervention that will improve older adults' access and adherence to treatment based on community and older people's perspectives; (2b) Establish a theory of change, i.e., expected factors that will need to be evaluated for change along with the intervention to explain how the intervention works. (3) Refine the intervention by collecting potential clients', community members', and health care providers' perspectives on the intervention's potential, design and the ideal delivery method.This work will help design a future randomized trial which will formally evaluate how effective the intervention is in improving access and adherence to treatment, as well as reducing social isolation among older people living with HIV in Uganda.

随着人们获得治疗的机会增加，人们的寿命更长，在撒哈拉以南非洲（SSA）的艾滋病毒感染者人数正在增加。特别是50岁或50岁以上的艾滋病毒携带者的人数预计将从20110万人增加到2040年的910万人。促进老年人获得抗网状病毒疗法（ART）的机会，使他们能够遵守他们的治疗能力，并且在他们的健康状况上是对自己的健康的关键，并且是“预防范围”的范围，这是Hevore the the the the spreter the spreter spretrer the spretrer。被预防社区所忽视，因为重点一直放在已知的艾滋病毒发病率很高的生殖健康，母亲到孩子的传播和年轻人群上。还有一个年龄段的神话，即老年人没有性活跃。成年人在老年时保持良好的性活跃，因为身体健康问题和/或性伴侣无法获得性活动，这在老年妇女中尤其如此。对美国HIV阳性老年人的研究发现，他们也保持性活跃，但超过40％的人不定期使用避孕套；非洲研究也产生了类似的结果。获得艺术可以保护自己的健康并降低其感染力。很少有研究检查老年人获得艾滋病毒治疗的障碍，并遵守治疗方法，并没有专门针对老年人的干预措施来改善艺术获取和依从性。乌干达的该项目将有助于证据解决有关老年人在SSA中对艺术获取和遵守障碍的知识的差距。尚不清楚障碍和促进者的艺术访问和依从性是否与年轻人口一样，或者与年轻人口一样，或者是否对其他人口良好的社会干预措施对其他人口有效地满足老年人的需求有效。老年人在SSA中对其他医疗服务的障碍包括高贫困率限制用于运输和护理的资金；多种多样；年龄歧视；健康提供者对老年人需求的了解很少。他们的福祉进一步暗示了社会隔离和与HIV相关的污名。该项目将是第一个开发量身定制的多管齐下的社会干预措施，该项目通过满足个人，社区和卫生系统级别的需求来识别和解决非洲人对艺术访问和遵守的障碍。在这个项目中，我们将开发和完善多方面的社会干预措施，以改善乌干达人中的依访，依从性，依从性和福祉。该项目的具体目的是：（1）使用与老年人，社区领导者和卫生保健工作者的访谈来确定老年人的艺术访问和遵守障碍和促进者。 （2a）制定一种干预措施，将根据社区和老年人的观点改善老年人的访问和遵守治疗； （2b）建立一种变化理论，即需要评估的预期因素以及干预措施，以解释干预措施的工作原理。 （3）通过收集潜在客户，社区成员和医疗保健提供者对干预措施的潜力，设计和理想交付方法的观点来完善干预措施。这项工作将有助于设计一项未来的随机试验，该试验将正式评估干预措施在改善治疗方面的效率，并减少在乌干达艾滋病患者中的社会隔离，并降低社会隔离。

项目成果

"We shall have gone to a higher standard": Training village heath teams (VHTs) to use a smartphone-guided intervention to link older Ugandans with hypertension and diabetes to care

“我们应该达到更高的标准”：培训乡村卫生团队 (VHT) 使用智能手机引导的干预措施将患有高血压和糖尿病的乌干达老年人联系起来进行护理

• DOI: 10.12688/aasopenres.13049.1
• 发表时间: 2020
• 期刊: AAS Open Research
• 作者: Mugisha J

Social engagement and survival in people aged 50 years and over living with HIV and without HIV in Uganda: a prospective cohort study.

乌干达 50 岁及以上艾滋病毒感染者和非艾滋病毒感染者的社会参与和生存：一项前瞻性队列研究。

• DOI: 10.2989/16085906.2018.1542322
• 发表时间: 2018
• 期刊: AJAR
• 作者: Mugisha JO

Additional file 1: of â For us here, we remind ourselvesâ : strategies and barriers to ART access and adherence among older Ugandans

附加文件 1：“对于我们来说，我们提醒自己”：乌干达老年人获取和遵守 ART 的策略和障碍

• DOI: 10.6084/m9.figshare.7659566
• 发表时间: 2019
• 作者: Schatz E