Decreasing Interruptions and Losses from HIV Care in Nigeria

减少尼日利亚艾滋病毒护理造成的中断和损失

• 批准号: 8541357
• 负责人: Aimalohi Ahonkhai
• 金额: $ 18.52万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-13 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8541357
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Adult; African; Aftercare; Behavior; Biometry; Caring; Characteristics; Chronic; Clinic; Community Outreach; Conflict (Psychology); Country; Critical Care; Data; Databases; Development; Ensure; Epidemiology; Evaluation; Fees; Food Supplementation; Frequencies; Goals; HIV; Half-Life; Health Services Accessibility; Health system; Healthcare; Home environment; Hour; Interruption; Intervention; K-Series Research Career Programs; Knowledge; Life; Life Expectancy; Medicine; Mentored Patient-Oriented Research Career Development Award; Methodology; Morbidity - disease rate; Nigeria; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Positioning Attribute; Predictive Factor; Primary Health Care; Process; Program Evaluation; Provider; Public Health; Research; Research Personnel; Research Training; Resources; Risk; Risk Factors; Services; Severity of illness; Site; South Africa; Statistical Methods; Support Groups; Surveys; Technical Expertise; Time; Training; Translating; Transportation; Uncertainty; Validation; Variant; Waiting Lists; Wellness Program; Work; antiretroviral therapy; base; care seeking; career; cohort; deprivation; design; effective intervention; experience; flexibility; follow-up; implementation research; implementation science; improved; insight; male; mortality; novel; programs; prospective; public health relevance; scale up; sex; skills; social stigma; theories; therapy design; treatment center; treatment program

DESCRIPTION (provided by applicant): With 160 million inhabitants, Nigeria is the most populous African nation, and home to the second largest number of people living with HIV/AIDS in the world (3.5 million). In Nigeria and other resource-limited countries (RLS), loss to follow-u (LTFU) poses a major challenge to the successful provision of chronic HIV care. One in four patients are lost-to-follow-up one year after initiating antiretroviral therapy (ART), resulting in loss of over half of the life expectancy gains provided by ART. While some patients are completely lost from HIV care, a lesser-studied group, approximately one in three, briefly interrupt but return to care. Our previous work in South Africa suggests that unplanned care interruptions portend poor patient outcomes. Many studies have characterized patient-level predictors of LTFU, but this knowledge has not enabled service providers to adequately improve patient retention. In addition, few studies have systematically assessed whether health system-level characteristics, which vary widely across treatment programs, predict LTFU and unplanned care interruption. Missing from the assessment of both patient and health system-level predictors of LTFU is an assessment of how these factors inform patient decisions to remain in HIV care, a concept known as "decisional conflict". My goal in this proposed K23 award is to utilize a novel framework incorporating health system and patient-level predictors of LTFU and unplanned care interruption, with determinants of patient decisional conflict. This will inform development of a pilot intervention to improve patient retention in HIV care in Nigeria. To accomplish this goal, I will study the AIDS Prevention Initiative Nigeria's (APIN) network in 32 comprehensive HIV treatment centers in 9 of Nigeria's 36 states. I will first investigate health system factors predictive of LTFU and unplanned care interruption by surveying clinic directors on a range of health system services available to their patients, and assessing outcomes of 1,500 patients over one year. I will then establish a cohort of 752 ART-eligible adults to determine the relationship of patient risk factors related to decisional conflict (disease severity stigma, resource deprivation and competing needs) about adhering to chronic HIV care, and the association between decisional conflict and both LTFU and unplanned care interruption one year after ART initiation. Finally, I will build on these findings to develop a pilot intervention n HIV-infected, ART-eligible patients based on a home-based HIV care construct to ameliorate decisional conflict by addressing both health system processes and patient obstacles to HIV care. The research proposed in this K23 award will build on my previous training in epidemiology and biostatistics, allow me to receive further training in quality improvement theory and methodology as well as technical expertise in large program evaluation and intervention design, and will ideally position me to launch my career as an investigator in HIV outcomes and implementation science in RLS.

描述（由申请人提供）：尼日利亚拥有 1.6 亿居民，是人口最多的非洲国家，也是世界上艾滋病毒/艾滋病感染者人数第二多的国家（350 万）。在尼日利亚和其他资源有限的国家 (RLS)，失访率 (LTFU) 对成功提供长期艾滋病毒护理构成了重大挑战。四分之一的患者在开始抗逆转录病毒治疗 (ART) 一年后失访，导致 ART 所带来的预期寿命损失超过一半。虽然有些患者完全无法接受艾滋病毒护理，但研究较少的一组患者（大约三分之一）会短暂中断但又重新接受护理。我们之前在南非的工作表明，计划外的护理中断预示着患者的预后不佳。许多研究已经描述了 LTFU 的患者水平预测因素，但这些知识并没有使服务提供商能够充分提高患者保留率。此外，很少有研究系统地评估卫生系统层面的特征（在不同治疗方案之间差异很大）是否可以预测 LTFU 和计划外护理中断。对患者和卫生系统层面 LTFU 预测因素的评估中缺少对这些因素如何影响患者决定继续接受 HIV 护理的评估，这一概念被称为“决策冲突”。我提出的 K23 奖项的目标是利用一个新颖的框架，将卫生系统和患者层面的 LTFU 预测因素和计划外护理中断以及患者决策冲突的决定因素结合起来。这将为试点干预措施的制定提供信息，以提高尼日利亚艾滋病毒护理中患者的保留率。为了实现这一目标，我将研究尼日利亚艾滋病预防倡议 (APIN) 的网络，该网络位于尼日利亚 36 个州中的 9 个州的 32 个综合艾滋病毒治疗中心。我将首先通过调查诊所负责人对其患者可用的一系列卫生系统服务，并评估 1,500 名患者一年内的结果，来调查预测 LTFU 和计划外护理中断的卫生系统因素。然后，我将建立一个由 752 名符合 ART 资格的成年人组成的队列，以确定与坚持长期 HIV 护理的决策冲突（疾病严重程度耻辱、资源剥夺和竞争性需求）相关的患者风险因素之间的关系，以及决策冲突与两者之间的关联。开始 ART 一年后 LTFU 和计划外护理中断。最后，我将在这些发现的基础上，基于家庭艾滋病毒护理结构，对艾滋病毒感染者、符合抗逆转录病毒疗法资格的患者制定一项试点干预措施，通过解决卫生系统流程和患者艾滋病毒护理障碍来改善决策冲突。 K23 奖项中提出的研究将建立在我之前在流行病学和生物统计学方面的培训的基础上，使我能够接受质量改进理论和方法以及大型项目评估和干预设计方面的技术专长方面的进一步培训，并使我能够理想地开展我的职业生涯是一名艾滋病毒结果和 RLS 实施科学的调查员。