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.

项目摘要 背景。为了满足UNAID的95-95-95，到2030年，艾滋病毒流行控制的快速目标 必须优先考虑艾滋病毒（PLHIV）实现和维持病毒抑制的人们（PLHIV）。迅速的 通过通用测试和治疗政策扩大抗逆转录病毒疗法（ART）已改善HIV治疗 人口水平的结果，但是艾滋病毒流行和反应的异质性在 病毒负荷结果。检查纵向病毒载荷结果以及塑造它们的多层次因素至关重要 用于地理优先级和艾滋病毒服务对不同的PLHIV群体的分化。 学习目标和目标。这项研究的目的是评估基础的模式，预测因素和机制 乌干达Rakai的PLHIV中的纵向病毒负荷结果（或轨迹）。这项研究的具体目的 是：1）确定病毒学衰竭和耐用病毒抑制的家庭和社区水平的预测指标 在人口水平的PLHIV中； 2）检查医疗机构特征 与病毒衰竭有关 在 设施水平； 3）探索社会，背景和卫生系统因素的机制 影响病毒负荷结果。拟议的研究与NIMH AIDS研究的重点一致 提前设计干预措施，超出了个人水平，延长了艾滋病毒护理的参与。 方法。这项剥削，顺序的混合方法研究将利用数据和基础结构 Rakai社区队列研究（RCCS），一项开放的，基于人群的人群研究，对15-49岁的个人 居住在乌干达Rakai的40个社区。 AIM 1是辅助数据分析测试是否钓鱼 社区居住，更高的社区层面移民以及家庭财富较低 在五年的随访中，病毒学衰竭的风险增加。 AIM 2将将RCC数据与程序化集成 元数据从161个医疗机构到横截面识别病毒学衰竭的复合材料相关性 每个设施的患者人数。 AIM 3以AIMS 1-2的发现为基础，将涉及主要的定性数据 通过对20-24个PLHIV和10-12名艾滋病毒临床医生的深入访谈进行收集。访谈将探索 AIM 1-2中确定的多层次因素的协同作用以及它们如何塑造PLHIV的病毒载荷结果随着时间的流逝。 AIMS 1-3的发现将进行三角测量，以丰富对显着HIV治疗差距的科学探究。 奖学金信息。拟议的研究将作为约瑟夫·罗森先生的博士学位论文 约翰·霍普金斯彭博公共卫生学院的博士生。培训由一名初选指导 赞助商，三个共同发起人和一名科学顾问，具有完善的方法论和主题 专业知识，包括与乌干达Rakai的PLHIV进行护理和治疗结果研究。培训计划将 准备罗森先生成为社会和行为科学领域的主要独立研究员 撒哈拉以南非洲的干预措施支持艾滋病毒护理中的参与和保留。