HIV Treatment Refusal Among Adults Presenting for Testing in Soweto, South Africa

南非索韦托，接受检测的成年人拒绝接受艾滋病毒治疗

基本信息

批准号：
8820283
负责人：
Ingrid T. Katz
金额：
$ 18.43万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-01 至 2016-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8820283
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Adopted Adult Africa South of the Sahara African Anti-Retroviral Agents Area Behavior Therapy Behavioral Sciences CD4 Lymphocyte Count Caring Categories Cells Client Clinic Counseling Country Data Early treatment Eligibility Determination Ensure Ethnography Event Feeling Foundations Goals Government Guidelines HIV HIV Infections HIV Seropositivity Health Personnel Health Services Accessibility Individual Influentials Intervention Intervention Trial Interview Learning Measures Medical Mental Health Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methods Mission Modeling Morbidity - disease rate National Institute of Mental Health Newly Diagnosed Outcome Policies Population Premature Mortality Provider Public Health Qualifying Quality of life Research Research Infrastructure Research Personnel Research Training Resources Risk Role Sampling Self Efficacy Sexual Partners Site Social Work Social support South Africa Structure Surveys Testing Translating Treatment Refusal Tuberculosis Universities Vulnerable Populations Woman Work World Health Organization antiretroviral therapy base career design effective intervention follow-up global health health belief health care service utilization high risk improved innovation men mortality multidisciplinary novel prevent programs response service utilization skills social success therapy design therapy development transmission process treatment program uptake

项目摘要

DESCRIPTION (provided by applicant): South Africa, the country with the most HIV-infected citizens globally, has the largest antiretroviral treatment (ART) program in the world. More than half of all South African adults have undergone voluntary counseling and testing (VCT) at least once. Unfortunately, these initiatives have not translated into early ART initiation. A substantial unmet need exists, with only 37% of the estimated 2 million HIV-infected ART-eligible individuals actually in care. The number of ART-eligible individuals will only increase, now that the government has adopted the new WHO guidelines, setting ART-eligibility at CD4 < 350 cells/mm3. To date, few studies have examined why millions of ART-eligible individuals in South Africa are not receiving treatment. We have identified a highly concerning phenomenon directly impacting ART uptake in South Africa. Over the course of 2009, 7,287 adults presented to a high-volume VCT site in Soweto. Ten percent (743) were found to be HIV-infected, and eligible to start immediate ART. We found that 148 (20%) of these clients refused to initiate ART upon learning their CD4 count, despite having a median CD4 of 110 cells/mm3. Though VCT is traditionally viewed as an entry point to treatment, these data underscore the importance of an unappreciated challenge in pre-ART care. To ensure the success of HIV treatment expansion, it will be essential to understand why individuals who qualify for ART choose not to initiate treatment. My goal with this K23 award is to identify modifiable determinants of ART-refusal, and design a targeted and informed intervention to counteract this phenomenon in Soweto, and prevent premature mortality in this vulnerable population. Using a mixed-methods approach, I will identify modifiable psycho-social determinants of ART-refusal by performing in-depth qualitative interviews with 40 ART-eligible adults presenting for VCT, and 10 healthcare providers, to inform category construction for a putative model based upon Anderson's Model of Healthcare Utilization. I will then examine correlates and outcomes of ART-refusal in 500 treatment-eligible adults, through survey implementation at the point of testing and for 6 months post-VCT. Finally, I will develop an intervention to promote HIV treatment acceptance among newly diagnosed HIV-infected individuals and pilot test it in a population of 100 treatment-eligible individuals. The proposed area of research addresses a critical area in pre-ART care, providing a theoretical and programmatic approach to improving ART uptake and acceptance among high-risk HIV-positive individuals in South Africa. The portfolio of research and training proposed for this K23 award will draw on my existing skills in HIV treatment and care, and global health program implementation. It will enable me to work with a multidisciplinary team of mentors across Harvard University and the University of Witwatersrand, and ultimately become a productive and influential independent investigator focused on improving ART acceptance.

描述（由申请人提供）：南非是全球艾滋病毒感染人数最多的国家，拥有世界上最大的抗逆转录病毒治疗（ART）计划。超过一半的南非成年人至少接受过一次自愿咨询和测试（VCT）。不幸的是，这些举措并未转化为早期 ART 的启动。一个实质性的存在未满足的需求，估计有 200 万符合 ART 资格的 HIV 感染者中只有 37% 真正得到护理。由于政府已采用新的世界卫生组织指南，将 ART 资格设定为 CD4 < 350 个细胞/mm3，因此符合 ART 资格的人数只会增加。迄今为止，很少有研究探讨为什么南非数百万符合 ART 资格的人没有接受治疗。我们发现了一个高度令人担忧的现象，该现象直接影响南非抗逆转录病毒治疗的采用。 2009 年期间，有 7,287 名成年人接受了索韦托高容量 VCT 网站的检查。百分之十 (743) 被发现感染艾滋病毒，并且有资格立即开始抗逆转录病毒治疗。我们发现，尽管 CD4 中位数为 110 个细胞/mm3，但这些客户中有 148 名 (20%) 在得知他们的 CD4 计数后拒绝启动 ART。尽管 VCT 传统上被视为治疗的切入点，但这些数据强调了 ART 前护理中未被重视的挑战的重要性。为了确保艾滋病毒治疗扩展的成功，必须了解为什么有资格接受抗逆转录病毒疗法的人选择不开始治疗。我获得 K23 奖项的目标是确定拒绝 ART 的可改变决定因素，并设计有针对性的知情干预措施来抵消索韦托的这一现象，并防止这一弱势群体过早死亡。使用混合方法，我将通过对 40 名参加 VCT 的符合 ART 资格的成年人和 10 名医疗保健提供者进行深入的定性访谈，确定拒绝 ART 的可改变的心理社会决定因素，为基于推定模型的类别构建提供信息基于安德森的医疗保健利用模型。然后，我将通过在测试时和 VCT 后 6 个月内实施的调查，检查 500 名符合治疗资格的成年人拒绝 ART 的相关性和结果。最后，我将制定一项干预措施，以促进新诊断的 HIV 感染者接受 HIV 治疗，并在 100 名符合治疗资格的个体中进行试点测试。拟议的研究领域涉及抗逆转录病毒治疗前护理的一个关键领域，为提高南非高危艾滋病毒阳性个体对抗逆转录病毒治疗的吸收和接受提供了理论和方案方法。为该 K23 奖项提出的研究和培训组合将利用我在艾滋病毒治疗和护理以及全球卫生计划实施方面的现有技能。它将使我能够与哈佛大学和威特沃特斯兰德大学的多学科导师团队合作，并最终成为一名富有成效且有影响力的独立研究者，专注于提高 ART 接受度。