Relationship Factors and Engagement in HIV Care in Malawi: A Dyadic Investigation

马拉维艾滋病毒护理中的关系因素和参与：二元调查

• 批准号: 9063920
• 负责人: Amy Anne Conroy
• 金额: $ 19.37万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-05 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9063920
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Adherence; Adult; Affect; Africa South of the Sahara; Applications Grants; Appointment; Area; Attention; Behavior Therapy; Behavioral; Belief; Biological Markers; Caring; Characteristics; Clinic; Clinical; Clinical Data; Communities; Conflict (Psychology); Continuity of Patient Care; Country; Couples; Data; Data Analyses; Development; Drops; Evaluation; Feedback; Focus Groups; Foundations; Goals; HIV; HIV Infections; Hair; Health behavior; Healthcare; Individual; Influentials; Intervention; Interview; Investigation; Knowledge; Life; Link; Malawi; Marriage; Measures; Medical; Medical Records; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Morbidity - disease rate; Multi-Drug Resistance; Outcome; Partner Communications; Patient Self-Report; Patients; Pharmaceutical Preparations; Play; Policies; Qualifying; Recording of previous events; Research; Research Activity; Research Design; Research Training; Resources; Respondent; Role; Sampling; Scientist; Series; Shapes; Social support; Specimen; Structure; Surveys; Testing; Time; Training; Training Activity; Training Support; Treatment Failure; Viral; Woman; antiretroviral therapy; authority; base; biomedical scientist; career; contextual factors; experience; learning strategy; meetings; member; mortality; pregnant; prevent; programs; public health relevance; randomized trial; resistant strain; sexual relationship; skills; success; theories; therapy adherence; therapy design; transmission process

 DESCRIPTION (provided by applicant): The purpose of this K01 is to provide the candidate with the training and mentorship to become an independent behavioral scientist with expertise on couple-based approaches to optimize engagement in the HIV care continuum (CC) in sub-Saharan Africa. Research on the HIV CC in sub-Saharan Africa has largely focused on structural and individual-level barriers and facilitators, resulting in a weak understanding of factors at the relationship level. A central component of this K01 award is the conduct of research on dyadic aspects of engagement in the HIV CC among couples living with HIV. The proposed research will be situated in Malawi, a resource-poor country in SSA where 11% of adults are HIV-infected and an estimated 8,000 Malawians die each year from AIDS-related illness. The majority of new HIV infections occur within marriage or cohabitating unions. Despite the success of ART programs in Malawi, large numbers of HIV+ individuals who are eligible for ART and who have initiated ART continue to drop out of the HIV CC. Furthermore, as more HIV+ individuals access ART while healthier, there are growing concerns about long-term adherence to ART. Using a dyadic, mixed-methods study design, the specific aims of the research are: 1) to describe how the relationship context influences engagement in the HIV CC within Malawian couples; 2) to identify the relationship-level barriers and facilitators that affec engagement in the HIV CC; and, 3) to develop a preliminary intervention to optimize engagement in the HIV CC for Malawian couples. For Aim 1, qualitative interviews will be conducted with 25 couples (50 individuals) with at least one partner who is either starting or already on ART. For Aim 2, the qualitative findings will be analyzed to develop a survey for 200 ART patients and their primary partner. The survey will collect information on relationship dynamics and characteristics, treatment knowledge and beliefs, contextual factors related to HIV care and treatment, and measures of engagement in the HIV CC (e.g., attendance at clinic appointments, adherence to ART).Medical record data and hair specimens will also be collected from respondents on ART to supplement self-reported measures of engagement in care. For Aim 3, 20 semi-structured interviews with community members and stakeholders, and 4 focus group discussions with couples will be conducted to inform the development of a relationship-focused intervention targeting optimal use of HIV care and treatment. Through this research plan, the candidate will gain practical training in four areas: (1) interpersonal theory to understand health behavior; (2) methodological skills to collect and analyze dyadic qualitative and quantitative data; (3) healthcare and clinical aspects of HIV/AIDS; and (4) behavioral intervention design and evaluation. An interdisciplinary team of mentors and scientific advisors will support the training and research plan through their combined expertise in couples-based research, dyadic data analysis, healthcare and medical management of HIV/AIDS, behavioral interventions for HIV/AIDS, and local knowledge of the Malawi context.

 描述（由适用提供）：该K01的目的是为候选人提供培训和心态，以成为一名独立的行为科学家，并在基于夫妇的方法方面具有专业知识，以优化撒哈拉以南非洲的HIV Care Continuum（CC）的参与度。撒哈拉以南非洲的HIV CC的研究主要集中在结构和个体层面和促进因子上，从而对关系水平的因素有较弱的理解。该K01奖的一个核心组成部分是对艾滋病毒伴侣艾滋病毒CC参与的二元方面的研究进行的。拟议的研究将位于马拉维，马拉维是SSA的一个资源贫乏的国家，其中11％的成年人感染了HIV，估计每年有8,000名马拉维人死于与艾滋病有关的疾病。大多数新的艾滋病毒感染发生在婚姻或同居工会内。尽管在马拉维取得了艺术计划的成功，但有资格获得艺术并发起艺术的大量艾滋病毒+个人继续退出HIV CC。此外，随着越来越健康的艾滋病毒+个人访问艺术，对长期遵守艺术的关注日益加剧。使用二元，混合方法研究设计，研究的具体目的是：1）描述关系环境如何影响马拉维夫妇中的HIV CC的参与度； 2）确定影响参与HIV CC的关系级别的障碍和促进者； 3）制定初步干预措施，以优化马拉维夫妇的HIV CC参与度。对于AIM 1，将对至少有一个开始或已经从事艺术的伴侣的25对夫妇（50个人）进行定性访谈。对于AIM 2，将分析定性发现，以开发200名艺术患者及其主要伴侣的调查。该调查将收集有关关系动态和特征，治疗知识和信念，与HIV护理和治疗有关的情境因素以及HIV CC的参与度量的信息（例如，参加临床任命，对艺术的遵守）也将从受访者那里收集，以补充自我报道的自我报道测量的研究。对于AIM 3，将与社区成员和利益相关者进行20次半结构化访谈，并将与夫妻进行4次焦点小组讨论，以告知针对艾滋病毒护理和治疗的最佳用途干预措施的发展。通过该研究计划，候选人将在四个领域获得实践培训：（1）了解健康行为的人际理论； （2）收集和分析二元定性和定量数据的方法学技能； （3）艾滋病毒/艾滋病的医疗保健和临床方面； （4）行为干预设计和评估。跨学科的导师和科学顾问团队将通过基于夫妻的研究，二元数据分析，艾滋病毒/艾滋病的医疗保健和医疗管理，艾滋病毒/艾滋病的行为干预以及马拉维环境的当地知识来支持培训和研究计划。