HIV Treatment Refusal Among Adults Presenting for Testing in Soweto, South Africa

南非索韦托，接受检测的成年人拒绝接受艾滋病毒治疗

基本信息

批准号：
8329936
负责人：
Ingrid T. Katz
金额：
$ 18.65万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8329936
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Adopted Adult Africa South of the Sahara African Anti-Retroviral Agents Area Behavior Therapy Behavioral Sciences CD4 Lymphocyte Count Caring Categories Cells Client Clinic Counseling Country Data Early treatment Eligibility Determination Ensure Ethnography Event Feeling Foundations Goals Government Guidelines HIV HIV Infections HIV Seropositivity Health Personnel Health Services Accessibility Individual Influentials Intervention Intervention Trial Interview Learning Measures Medical Mental Health Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Mission Modeling Morbidity - disease rate National Institute of Mental Health Newly Diagnosed Outcome Policies Population Premature Mortality Provider Public Health Qualifying Quality of life Research Research Infrastructure Research Personnel Research Training Resources Risk Role Sampling Self Efficacy Sexual Partners Site Social Work Social support South Africa Structure Surveys Testing Translating Treatment Refusal Tuberculosis Universities Vulnerable Populations Woman Work World Health Organization antiretroviral therapy base career design effective intervention follow-up global health health belief health care service utilization high risk improved innovation men mortality multidisciplinary novel prevent programs response service utilization skills social success therapy design therapy development transmission process treatment program uptake

项目摘要

DESCRIPTION (provided by applicant): South Africa, the country with the most HIV-infected citizens globally, has the largest antiretroviral treatment (ART) program in the world. More than half of all South African adults have undergone voluntary counseling and testing (VCT) at least once. Unfortunately, these initiatives have not translated into early ART initiation. A substantial unmet need exists, with only 37% of the estimated 2 million HIV-infected ART-eligible individuals actually in care. The number of ART-eligible individuals will only increase, now that the government has adopted the new WHO guidelines, setting ART-eligibility at CD4 < 350 cells/mm3. To date, few studies have examined why millions of ART-eligible individuals in South Africa are not receiving treatment. We have identified a highly concerning phenomenon directly impacting ART uptake in South Africa. Over the course of 2009, 7,287 adults presented to a high-volume VCT site in Soweto. Ten percent (743) were found to be HIV-infected, and eligible to start immediate ART. We found that 148 (20%) of these clients refused to initiate ART upon learning their CD4 count, despite having a median CD4 of 110 cells/mm3. Though VCT is traditionally viewed as an entry point to treatment, these data underscore the importance of an unappreciated challenge in pre-ART care. To ensure the success of HIV treatment expansion, it will be essential to understand why individuals who qualify for ART choose not to initiate treatment. My goal with this K23 award is to identify modifiable determinants of ART-refusal, and design a targeted and informed intervention to counteract this phenomenon in Soweto, and prevent premature mortality in this vulnerable population. Using a mixed-methods approach, I will identify modifiable psycho-social determinants of ART-refusal by performing in-depth qualitative interviews with 40 ART-eligible adults presenting for VCT, and 10 healthcare providers, to inform category construction for a putative model based upon Anderson's Model of Healthcare Utilization. I will then examine correlates and outcomes of ART-refusal in 500 treatment-eligible adults, through survey implementation at the point of testing and for 6 months post-VCT. Finally, I will develop an intervention to promote HIV treatment acceptance among newly diagnosed HIV-infected individuals and pilot test it in a population of 100 treatment-eligible individuals. The proposed area of research addresses a critical area in pre-ART care, providing a theoretical and programmatic approach to improving ART uptake and acceptance among high-risk HIV-positive individuals in South Africa. The portfolio of research and training proposed for this K23 award will draw on my existing skills in HIV treatment and care, and global health program implementation. It will enable me to work with a multidisciplinary team of mentors across Harvard University and the University of Witwatersrand, and ultimately become a productive and influential independent investigator focused on improving ART acceptance. PUBLIC HEALTH RELEVANCE: Antiretroviral treatment-refusal is a critical public health concern, since early treatment initiation decreases the risk of premature mortality and reduces the rate of HIV transmission to sexual partners, the predominant method of transmission in sub-Saharan Africa. This research will shift current practice by providing a theoretical and programmatic approach to counteract ART-refusal among high-risk HIV-positive individuals in a resource-limited setting.

描述（由申请人提供）：南非是全球感染了HIV的公民的国家，拥有世界上最大的抗逆转录病毒治疗计划（ART）计划。在所有南非成年人中，有一半以上至少接受过一次自愿咨询和测试（VCT）。不幸的是，这些举措尚未转化为早期的艺术启动。实质性存在未满足的需求，实际上有37％的估计有200万名HIV感染的艾滋病毒符合艺术资格的人。既然政府已经采用了新的WHO指南，将艺术资格设定为CD4 <350 Cells/mm3。迄今为止，很少有研究研究为什么南非有数百万符合艺术资格的人没有接受治疗。我们已经确定了一种高度关注的现象，直接影响了南非的艺术吸收。在2009年的过程中，有7,287名成年人出现在索韦托的一个大批量VCT站点上。发现百分之十（743）是感染了HIV的，并且有资格开始直接艺术。我们发现，尽管中位CD4为110个细胞/mm3，但这些客户中有148名（20％）拒绝在学习CD4计数时启动ART。尽管传统上将VCT视为治疗的切入点，但这些数据强调了在艺术前护理中未引起挑战的重要性。为了确保艾滋病毒治疗扩展的成功，必须了解为什么有资格获得艺术的个人选择不开始治疗。我的这一K23奖的目标是确定可修改的艺术狂欢决定因素，并设计有针对性和知情的干预措施来抵消Soweto中这种现象，并防止这种脆弱人群的过早死亡。使用混合方法方法，我将通过对40名符合VCT的艺术资格成年人和10个医疗保健提供者进行深入的定性访谈，以确定可修改的心理社会社会决定因素，以根据Anderson的医疗保健利用模型为定义模型提供信息。然后，我将通过测试时和VCT后6个月的调查实施来检查500名符合治疗条件的成年人的相关性和结果。最后，我将制定一项干预措施，以促进新诊断的艾滋病毒感染者的艾滋病毒治疗接受，并在100个符合治疗条件的人群中对其进行试验对其进行测试。拟议的研究领域介绍了艺术前护理中的关键领域，为改善南非高风险艾滋病毒阳性人群的艺术吸收和接受提供了一种理论和程序化方法。该K23奖提议的研究和培训组合将借鉴我现有的HIV治疗和护理方面的技能以及全球健康计划的实施。这将使我能够与哈佛大学和威特沃特斯兰德大学的跨学科导师团队合作，并最终成为一名致力于改善艺术接受度的富有成效且有影响力的独立调查员。公共卫生相关性：抗逆转录病毒治疗 - 狂欢是一个至关重要的公共卫生问题，因为早期治疗开始降低了过早死亡的风险，并降低了向性伴侣传播HIV的率，这是撒哈拉以南非洲的主要传播方法。这项研究将通过在资源有限的环境中提供一种理论和程序化方法来改变当前的实践。