Viral Load Trajectories and Dynamics among People Living with HIV in Rakai, Uganda: A Mixed-Methods Study

乌干达拉凯艾滋病毒感染者的病毒载量轨迹和动态：一项混合方法研究

• 批准号: 10327102
• 负责人: Joseph Gregory Rosen
• 金额: $ 4.6万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-02 至 2024-04-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10327102
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Advanced Development; Africa South of the Sahara; Automobile Driving; Behavioral Research; Behavioral Sciences; Caring; Catchment Area; Characteristics; Clinical; Cohort Studies; Communities; Data; Data Analyses; Data Collection; Decision Making; Epidemic; Epidemiology; Failure; Fellowship; Fishes; Funding; Geography; Goals; HIV; Health care facility; Health system; Heterogeneity; Household; Individual; Intercept; Intervention; Interview; Linear Regressions; Measures; Mentorship; Metadata; Methodology; Methods; Modeling; Modification; National Institute of Mental Health; Outcome; Outcomes Research; Patients; Pattern; Policies; Population; Prevalence; Prospective Studies; Public Health Schools; Recording of previous events; Regimen; Research; Research Personnel; Research Priority; Risk; Sampling; Scientific Inquiry; Services; Shapes; Social Sciences; Surveys; Techniques; Testing; Time; Training; Treatment outcome; Uganda; Viral; Viral Load result; Viremia; Visit; aged; antiretroviral therapy; base; care outcomes; cohesion; cohort; contextual factors; data infrastructure; data integration; demographic disparity; design; doctoral student; experience; follow-up; improved; innovation; insight; men; migration; novel; patient population; population based; programs; prospective; residence; response; scale up; service delivery; skills; social; synergism; therapy adherence; therapy design; therapy development; treatment adherence; treatment optimization; virology

PROJECT SUMMARY Background. To meet the UNAIDS 95-95-95 Fast Track targets for HIV epidemic control by 2030, strategies that support people living with HIV (PLHIV) to achieve and maintain viral suppression must be prioritized. Rapid scale-up of antiretroviral therapy (ART) through Universal Test and Treat policies has improved HIV treatment outcomes at population level, but heterogeneities in the HIV epidemic and response have yielded disparities in viral load outcomes. Examining longitudinal viral load outcomes, and the multilevel factors shaping them, is vital for geographic prioritization and differentiation of HIV services to distinct groups of PLHIV. Study Goal and Aims. The goal of this study is to assess patterns, predictors, and mechanisms underpinning longitudinal viral load outcomes (or trajectories) among PLHIV in Rakai, Uganda. The specific aims of this study are to: 1) Identify household and community-level predictors of virologic failure and durable viral suppression among PLHIV at population level; 2) Examine health facility characteristics associated with virologic failure at facility level; and 3) Explore the mechanisms through which social, contextual, and health systems factors influence viral load outcomes. The proposed research aligns with NIMH Division of AIDS Research priorities to advance design of interventions, delivered beyond the individual level, prolonging engagement in HIV care. Approach. This explanatory, sequential mixed-methods study will leverage the data and infrastructure of the Rakai Community Cohort Study (RCCS), an open, population-based cohort study of individuals aged 15-49 years residing in 40 communities in Rakai, Uganda. Aim 1 is a secondary data analysis testing whether fishing community residence, higher community-level migration, and lower household wealth are associated with increased risk of virologic failure over five years of follow-up. Aim 2 will integrate RCCS data with programmatic metadata from 161 health facilities to cross-sectionally identify compositional correlates of virologic failure in each facility’s patient population. Building on findings from Aims 1-2, Aim 3 will involve primary qualitative data collection through in-depth interviews with 20-24 PLHIV and 10-12 HIV clinicians. Interviews will explore synergies in multilevel factors identified in Aims 1-2 and how they shape PLHIV’s viral load outcomes over time. Findings from Aims 1-3 will be triangulated to enrich scientific inquiry into salient HIV treatment gaps. Fellowship Information. The proposed research will serve as the doctoral dissertation of Mr. Joseph Rosen, a PhD student at the Johns Hopkins Bloomberg School of Public Health. The training is guided by one Primary Sponsor, three Co-Sponsors, and one Scientific Advisor with complementary methodological and topical expertise, including care and treatment outcomes research with PLHIV in Rakai, Uganda. The training plan will prepare Mr. Rosen to become a leading independent researcher in the social and behavioral sciences, focused on interventions in sub-Saharan Africa supporting engagement and retention in HIV care.

项目概要 背景 为了实现联合国艾滋病规划署 95-95-95 到 2030 年控制艾滋病毒流行的快速通道目标，战略 必须优先考虑支持艾滋病毒感染者 (PLHIV) 实现和维持病毒抑制。 通过普遍检测和治疗政策扩大抗逆转录病毒治疗 (ART) 改善了艾滋病毒治疗 人口层面的结果，但艾滋病毒流行和应对措施的异质性导致了 检查纵向病毒载量结果以及影响它们的多层次因素至关重要。 为不同的感染者群体提供艾滋病毒服务的地理优先顺序和差异化。 研究目的和目的 本研究的目标是评估模式、预测因素和支撑机制。 乌干达拉凯感染者的纵向病毒载量结果（或轨迹） 本研究的具体目的。 目的是： 1) 确定家庭和社区层面病毒学失败和持久病毒抑制的预测因素 人群层面的艾滋病病毒感染者；2) 检查卫生设施的特征 与病毒学失败相关 在 设施层面；以及 3) 探索影响社会、背景和卫生系统因素的机制 拟议的研究与 NIMH 艾滋病研究部门的优先事项一致 设计超越个人层面的干预措施，延长对艾滋病毒护理的参与。 这种解释性、顺序混合方法研究将利用数据和基础设施。 Rakai 社区队列研究 (RCCS)，一项针对 15-49 岁个体的开放、基于人群的队列研究 居住在乌干达拉凯的 40 个社区，目标 1 是测试是否钓鱼的二次数据分析。 社区居住、较高的社区级别迁移和较低的家庭财富与 五年随访期间病毒学失败的风险增加，目标 2 将 RCCS 数据与程序化整合。 来自 161 个卫生机构的元数据，用于横断面识别病毒学失败的成分相关性 基于目标 1-2 的调查结果，目标 3 将涉及主要定性数据。 通过对 20-24 名艾滋病毒感染者和 10-12 名艾滋病毒牧师的深入访谈收集。 目标 1-2 中确定的多层次因素的协同作用以及它们如何随着时间的推移影响 PLHIV 的病毒载量结果。 目标 1-3 的调查结果将进行三角测量，以丰富对艾滋病毒治疗的显着差距的科学探究。 奖学金信息。拟议的研究将作为约瑟夫·罗森先生的博士论文。 约翰·霍普金斯大学彭博公共卫生学院的博士生培训由一名小学负责人指导。 赞助商、三名联合赞助商和一名科学顾问，具有互补的方法和主题 培训计划将包括乌干达拉凯艾滋病毒感染者的护理和治疗结果研究。 帮助罗森先生成为社会和行为科学领域领先的独立研究员，专注于 关于在撒哈拉以南非洲地区支持参与和保留艾滋病毒护理的干预措施。