Promoting Engagement in the Drug Resistant TB/HIV Care Continuum in South Africa

促进南非耐药结核病/艾滋病毒护理连续体的参与

• 批准号: 9894715
• 负责人: Max O'Donnell
• 金额: $ 50.23万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-10 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9894715
• 关键词: AIDS/HIV problem; Address; Adherence; Adverse effects; Behavioral; Behavioral Sciences; Caring; Cause of Death; Clinical; Communities; Complex; Continuity of Patient Care; Critical Care; Data; Drug resistance; Drug resistance in tuberculosis; Epidemic; Extreme drug resistant tuberculosis; Focus Groups; Generations; Goals; HIV; HIV/TB; Health Personnel; Health system; Hospitals; Incidence; Individual; International; Interruption; Intervention; Interview; Lead; Link; Measures; Methods; Modeling; Modern Medicine; Morbidity - disease rate; Motivation; Multidrug-Resistant Tuberculosis; Outcome; Outpatients; Patient Care; Patients; Pharmaceutical Preparations; Population; Predictive Value; Qualitative Methods; Reporting; Research; Resistance; Risk Factors; Self Administration; Self Medication; Social Behavior; South Africa; South African; Structure; Treatment outcome; Tuberculosis; Viral; acquired drug resistance; antiretroviral therapy; base; evidence base; group intervention; implementation science; improved; innovation; intervention effect; medication compliance; mortality; novel; novel therapeutics; outcome prediction; patient engagement; patient oriented; patient-level barriers; pill; public health relevance; skills; social stigma; social structure; standard of care; theories; transmission process; tuberculosis drugs

 DESCRIPTION (provided by applicant): Tuberculosis (TB) remains the leading cause of morbidity and mortality worldwide among people living with HIV. Globally, the incidence of multidrug-resistant tuberculosis and extensively drug resistant tuberculosis, the most drug-resistant forms of TB, has approximately doubled over the past fifteen years. Nowhere has this increased incidence generated more concern than South Africa where interactions between TB and generalized HIV/AIDS epidemics are causing `explosive' TB incidence and case-fatality threatening to undermine the progress reached with antiretroviral therapy (ART). Medication adherence, a key predictor of outcomes in multi-and extensively drug-resistant TB (M/XDR-TB) and HIV treatment, is understudied in high burden TB/HIV settings. Patient losses during transitions in the TB/HIV care continuum are frequent and lead to increased mortality. Demands of M/XDR-TB HIV treatment are severe including extraordinary pill burden, severe adverse effects, lengthy treatment, isolation, and stigma, with few parallels in modern medicine. The goal of the proposed study is to enhance adherence and retention in care for M/XDR- TB HIV patients in South Africa through a community-based strategy, including use of community adherence groups, with the overarching goal of promoting patient engagement in a continuum of M/XDR-TB HIV care. Although well established for ART, this is the first application of a community adherence group intervention to an M/XDR-TB HIV co-infected population. To achieve this goal, we will characterize critical implementation gaps in our understanding of adherence to treatment for drug-resistant TB and HIV, use this data to inform an evidence and theory-based intervention to improve adherence and promote retention in care, and rigorously evaluate the intervention with a mixed methods approach using quantitative clinical outcomes and qualitative understanding of impact on barriers and facilitators At the conclusion of these studies we will have addressed critical gaps in our understanding of adherence to treatment for drug-resistant TB and HIV, evaluated the potentially predictive value of novel adherence measures and assessed the impact of an exploratory, culturally acceptable, and patient-oriented intervention to support adherence.

 描述（由适用提供）：结核病（TB）仍然是艾滋病毒感染者在全球发病率和死亡率的主要原因。在全球范围内，在过去的十五年中，多药耐药性结核病和广泛的耐药性结核病的发生率大约翻了一番。这一事件的增加，没有比南非更多的关注点，因为结核病与广义艾滋病毒/艾滋病发作之间的相互作用导致“爆炸性”结核病的发病率和案件合作危险威胁着抗逆转录病毒疗法（ART）的进展。在高燃烧TB/HIV环境中，可以理解药物依从性，这是多种和广泛抗药性结核病（M/XDR-TB）和HIV治疗的主要预测因子。结核病/艾滋病毒护理过渡期间的患者损失频繁会导致死亡率增加。 M/XDR-TB HIV治疗的需求严重，包括非凡的药丸，严重的不良反应，冗长的治疗，隔离和污名，在现代医学中很少有相似之处。拟议的研究的目的是通过基于社区的策略（包括使用社区依从性群体）来增强南非M/XDR-TB HIV患者的依从性和保留率，其目标是促进患者参与M/XDR-TB HIV Care的持续性。尽管在艺术中建立了良好的建立，但这是社区遵守组干预措施与M/XDR-TB HIV共同感染的人群的第一次应用。为了实现这一目标，我们将在对依从性治疗耐药性结核病和艾滋病毒治疗方面的理解中表征关键的实施差距，使用这些数据为基于证据和理论的干预提供信息，以提高依从性并促进保留率，并严格评估使用混合方法的方法，并通过对障碍的范围进行定量的研究来确定这些研究的范围，以确定这些研究的范围，并确定这些研究的范围，我们将对这些研究的影响置于这些研究中，以了解这些研究的研究，以了解这些研究的范围。遵守耐药性结核病和HIV的治疗，评估了新型依从性测量的潜在预测价值，并评估了探索性，在文化上可接受且面向患者的干预措施支持依从性的影响。