What happens after diagnosis: Characterizing long-term HIV care trajectories and mortality in South Africa

诊断后会发生什么：描述南非长期艾滋病毒护理轨迹和死亡率

基本信息

批准号：
9140315
负责人：
Ingrid Valerie Bassett
金额：
$ 45.17万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-07 至 2020-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9140315
关键词：
Academia Achievement Africa South of the Sahara Behavioral Behavioral Model Behavioral Sciences Biometry CD4 Lymphocyte Count Caring Censuses Cessation of life Clinical Cohort Studies Communities Consent Continuity of Patient Care Data Data Sources Diagnosis Disease Effectiveness Emotional Funding Future Geographic Factor Geographic Information Systems Geographic Locations Government HIV HIV diagnosis Health Health Benefit Healthcare Systems Hot Spot Human immunodeficiency virus test Individual Intervention Laboratories Life Life Expectancy Long-Term Care Longitudinal Studies Measures Monitor Morbidity - disease rate Movement National Institute of Mental Health Nature Newly Diagnosed Nonlinear Dynamics Outcome Participant Patients Pattern Patterns of Care Performance Physicians Play Population Positioning Attribute Public Health Registries Reporting Research Research Personnel Resources Risk Factors Services Social Behavior Social support South Africa South African Staging Statistical Data Interpretation Statistical Models Study Subject Testing Time Viral Load result Work antiretroviral therapy base clinical epidemiology clinical research site cohort design effective intervention health service use high risk improved innovation mortality novel novel strategies prevent programs public health relevance social success therapy adherence therapy design tool transmission process treatment program treatment site uptake

项目摘要

DESCRIPTION (provided by applicant): Widespread uptake of potent antiretroviral therapy (ART) for HIV holds the promise of reducing morbidity and HIV transmission - but requires consistent engagement with the health care system. South Africa has the largest ART program in the world, with 2.4 million people on treatment. Yet despite this unprecedented accomplishment, UNAIDS estimates that ~60% of people in South Africa in need of treatment are still not accessing ART. This reflects attrition from the multiple critical steps on the path fom HIV testing to linkage to HIV care to lifelong ART and virologic suppression. Previous research on patient attrition from the HIV care cascade has focused on cross-sectional snapshots of points on the care continuum. This approach fails to capture long-term, dynamic patient movement into and out of the cascade. Improvement in each step of the continuum must be achieved together to improve overall rates of virologic suppression and survival. Only by understanding patient, structural, and geographic factors that contribute to suboptimal progression through the continuum of care can we design effective interventions that target those at highest risk for poor care engagement. Innovative means of assessing patient progression longitudinally and across different treatment sites are needed to assess the dynamic, non-linear nature of the HIV care continuum. Leveraging a well-characterized cohort of nearly 2,000 HIV-infected people drawn from an NIMH- funded trial in South Africa (R01MH090326), we will assess 5-year HIV care trajectories, characterizing patients via group-based statistical modeling based on a combination of national laboratory data and death registry information. Because cohort study subjects were consented prior to HIV testing, in a variety of clinical sites and with a wide spectrum of presenting CD4 counts, we will be able to characterize risk factors for different long-term trajectories for a wide variety of patient types. In addition,we will define geographic areas associated with poor engagement in care using spatial analysis of care trajectories and 2011 South African census data. We propose the following three specific aims: (1) To assess rates and sociobehavioral predictors of 5-year mortality following HIV testing adjusting for baseline and 9-month clinical factors, (2) To identify distinct long-term HIV care trajectories based on the pattern of CD4 counts and viral loads (such as in care, care interrupters, and not in care) and to assess sociobehavioral factors associated with membership in one of these trajectories, and (3) To use geographic information system and spatial statistical analysis to identify "hot spots" associated with a higher likelihood of inconsistent long-term HIV care trajectories and higher mortality. This study will be among the first to examine longitudinal engagement in care for people newly- diagnosed with HIV. Our novel approach will help researchers and policymakers craft effective interventions targeting sub-populations of HIV-infected individuals and geographic areas with a higher likelihood of poor HIV care engagement. These findings can improve HIV care at the individual, program and community levels.

描述（由适用提供）：HIV的潜在抗逆转录病毒疗法（ART）的宽度吸收有望降低发病率和HIV传播 - 但需要与医疗保健系统保持一致。南非拥有世界上最大的艺术计划，有240万人接受治疗。然而，目的地这个前所未有的成就，UNAID估计，约60％的南非需要治疗的人仍无法获得艺术。这反映了FOM HIV测试的多个关键步骤，即与HIV护理与终身艺术和病毒学抑制的联系。先前对HIV护理级联的患者属性的研究重点是护理连续体上点的横断面快照。这种方法无法捕获长期，动态的患者运动进入级联。必须共同提高连续体的每个步骤，以提高病毒学抑制和生存的总体速率。只有通过理解患者，结构和地理因素，从而通过持续护理来促进次优的进展，我们才能设计有效的干预措施，以针对那些患有不良护理的风险最高的干预措施。需要纵向评估患者进展的创新手段，并在不同的治疗部位进行评估，以评估HIV护理连续体的动态，非线性性质。我们利用近2,000名来自南非NIMH志趣相投的试验中的HIV感染者（R01MH090326）来评估5年的HIV HIV护理轨迹，通过基于基于组的统计模型来表征患者，基于国家实验室数据和死亡分数信息的组合来表征患者。由于在HIV测试之前，在各种临床部位以及各种呈现CD4计数的范围内同意了队列研究对象，因此我们将能够表征多种患者类型的不同长期轨迹的风险因素。此外，我们将使用对护理轨迹的空间分析和2011年南非人口普查数据来定义与参与护理不佳相关的地理区域。我们提出以下三个具体目的：（1）评估艾滋病毒测试调整基线和9个月临床因素后5年死亡率的率和社会行为预测因素（2），以识别不同的长期HIV 护理轨迹基于CD4计数和病毒载荷的模式（例如在护理，护理，诊断器和不护理中），并评估与其中一种轨迹相关的社会行为因素，（3）使用地理信息系统和空间统计分析来识别“与较高的长期护理相关的Hot Spots”，而HOT Spots则具有更高的nif careist tragity and nive niv tragies andiv tragies tragies and afteries tragies andiv tragies tragies tragies tragies tragies trafority and socraphing trapory and Spots。这项研究将是最早检查纵向的研究从事新诊断艾滋病毒的人的照顾。我们的新方法将帮助研究人员和政策制定者制定有效的干预措施，以针对感染HIV的个体和地理区域的亚人群，其可能性较高的HIV护理参与度。这些发现可以改善个人，计划和社区层面的艾滋病毒护理。