Evaluating UTT with a National HIV Cohort to Optimize South Africa's HIV Response (ENCORE)

通过国家 HIV 队列评估 UTT 以优化南非的 HIV 应对措施 (ENCORE)

• 批准号: 10397416
• 负责人: Jacob Bor
• 金额: $ 31.91万
• 依托单位: WITS HEALTH CONSORTIUM (PTY), LTD
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10397416
• 关键词: Africa; Boston; CD4 Lymphocyte Count; Caring; Clinic; Clinic Visits; Clinical; Clinical Trials; Collaborations; Complement; Country; Data; Databases; Diagnosis; Effectiveness; Eligibility Determination; Epidemic; Evaluation; Event; Future; HIV; Health; Interruption; Intervention; Laboratories; Link; Monitor; Patients; Pattern; Persons; Pharmaceutical Preparations; Phase; Policies; Population Surveillance; Predictive Value; Public Sector; Recording of previous events; Records; Research; Series; Services; South Africa; System; Testing; Time; Universities; Update; Viral; Viral Load result; antiretroviral therapy; base; care seeking; case finding; cohort; design; follow-up; individual patient; innovation; novel; programs; response; study population; treatment program; uptake

Project Summary Universal Test-and-Treat (UTT) could end the HIV epidemic if enough people start and stay on treatment. In 2016, South Africa eliminated CD4 eligibility criteria for antiretroviral therapy (ART) and, in 2017, the country moved to start patients on the same day as diagnosis. These policies were designed to increase ART coverage and have been shown to be effective in clinical trials. However, the real-world effectiveness of these UTT policies at scale is not known. Understanding the impact of UTT and at what stages of the UTT cascade patients are lost will be critical to guide the next phase of South Africa’s HIV response. In collaboration with the National Health Laboratory Service (NHLS), we previously developed a National HIV Cohort by de-duplicating the complete laboratory records of South Africa’s public sector HIV program (>12 million patients at >4000 facilities since 2004). The unique patient identifier that we created and validated enables longitudinal follow-up of all patients nationally from clinical presentation to viral suppression regardless of where they seek care. The cohort is unique in its ability to follow patients who transfer to other facilities without informing their prior clinic. However, it is limited in its ability to assess events that do not include a laboratory test, such as medication pickups. For this proposal, we will update the NHLS National HIV Cohort through the UTT era and link it with data from South Africa’s facility-based ART monitoring and evaluation system. We will use this integrated cohort to quantify losses at each stage of the UTT cascade and to assess systemwide retention and transfer in the UTT era. We will then evaluate the impact of two UTT policies – eliminating CD4 criteria and implementing same- day ART – on time from clinical presentation to ART uptake, retention, and viral suppression. South Africa has the largest HIV treatment program in the world. Yet until recently, just half of HIV-infected people in South Africa were virally-suppressed. UTT was South Africa’s largest HIV policy shift since the initial ART rollout in 2004. Our study is innovative because it offers a unique national, longitudinal view of the HIV care cascade in South Africa. Our study is significant because we will determine the extent to which UTT has increased ART coverage and viral suppression and we will identify where in the UTT cascade patients leave care, illuminating opportunities for intervention.

项目摘要 如果足够的人开始接受治疗，普遍的测试和治疗（UTT）可能会结束HIV流行。在 2016年，南非取消了抗逆转录病毒疗法（ART）的CD4资格标准，并于2017年 移动以诊断的同一天开始患者。这些政策旨在增加艺术 覆盖范围并已显示在临床试验中有效。但是，这些的现实有效性 规模上的UTT政策尚不清楚。了解UTT的影响以及UTT级联的阶段 失去患者至关重要的是指导南非艾滋病毒反应的下一阶段。 我们与国家卫生实验室服务（NHLS）合作，以前开发了一份全国艾滋病毒 通过删除南非公共部门艾滋病毒计划的完整实验室记录（> 12 自2004年以来，有4000个设施的百万患者）。我们创建和验证的独特患者标识符 从临床表现到病毒抑制的所有全国患者的纵向随访，无论如何 他们寻求照顾的地方。该队列在跟随转移到其他设施的患者的能力方面是独一无二的 没有通知他们先前的诊所。但是，它评估不包括一个事件的能力有限 实验室测试，例如药物拾取。 对于此建议，我们将通过UTT擦除更新NHLS国家HIV队列，并将其与来自 南非基于设施的艺术监测和评估系统。我们将使用这个集成的队列 量化UTT级联的每个阶段的损失，并评估UTT的系统范围内保留和转移 时代。然后，我们将评估两种UTT政策的影响 - 消除CD4标准并实施相同的影响 - 日常艺术 - 从临床表现到艺术吸收，保留和病毒抑制的准时。 南非是世界上最大的艾滋病毒治疗计划。直到最近，只有一半的艾滋病毒感染者 南非的人们几乎被施加了抑制。自首次发行以来，UTT是南非最大的艾滋病毒政策转变 2004年的艺术推广。我们的研究具有创新性，因为它为艾滋病毒提供了独特的民族，纵向视野 在南非护理级联。我们的研究很重要，因为我们将确定UTT的程度 增加了艺术覆盖范围和病毒抑制，我们将确定在UTT级联患者中的位置 护理，启发干预的机会。