The South African National HIV Pregnancy Cohort: evaluating continuity of care among women living with HIV

南非国家艾滋病毒妊娠队列：评估感染艾滋病毒的妇女的护理连续性

• 批准号: 10624761
• 负责人: Kate Clouse
• 金额: $ 31.25万
• 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: 2020-04-03 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10624761
• 关键词: Address; Award; Big Data; Blood Tests; Blood specimen; Breast Feeding; CD4 Lymphocyte Count; Caring; Clinical; Clinical Data; Continuity of Patient Care; Country; Data; Databases; Development; Drops; Ensure; Epidemiology; Frequencies; General Population; Guidelines; HIV; Health; Health Services Accessibility; High Risk Woman; Home; Individual; Infant; Intervention; Knowledge; Laboratories; Machine Learning; Measures; Monitor; Morbidity - disease rate; Mother-to-child HIV transmission; Movement; Patient Transfer; Patients; Performance; Perinatal; Persons; Policies; Policy Maker; Population; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Provider; Public Sector; Research Personnel; Risk; Risk Factors; Series; Services; Sexual Partners; Site; South Africa; South African; Specific qualifier value; System; Techniques; Testing; Time; Vertical Disease Transmission; Viral; Viral Load result; Viremia; Woman; Work; antenatal; antenatal care; antiretroviral therapy; cohort; data tools; design; follow-up; health economics; high risk; improved; innovation; mortality; novel; patient mobility; post pregnancy; postpartum care; predictive modeling; programs; success; tool; transmission process; treatment program; trend; viral transmission

ABSTRACT For the first time on a national level, we propose to utilize routinely-collected laboratory data to develop a cohort of pregnant women living with HIV in South Africa in a way that is uniquely robust to transfer across facilities. South Africa is home to more people living with HIV than any other country, and nearly one in three pregnant women attending antenatal care is living with HIV. Access to antiretroviral therapy (ART) has increased substantially since the start of the national ART program in 2004, with >95% ART coverage during pregnancy and delivery, and mother-to-child transmission of HIV greatly reduced. However, our work has demonstrated that women who initiate ART during pregnancy are at heightened risk of dropping out of care, particularly after delivery, leading to the potential for viral transmission, morbidity and mortality. It is difficult to evaluate the success of policies of expanded access to ART care, and assess continuity of care, due to the lack of a national longitudinal HIV care database. In addition, patient movement between unlinked facilities means that self-transfer often is misclassified as loss to care. To address this major shortcoming, our team at the Health Economics and Epidemiology Office (HE2RO) partnered with the South African National Health Laboratory Services in 2015 to use existing HIV-related laboratory data to create the South African National HIV Cohort. Now, through this five-year award, we propose to expand this successful project to use routinely- collected laboratory data to develop a cohort of pregnant women living with HIV in South Africa. We propose three specific aims. First, we will develop and validate a novel national cohort of pregnant women accessing HIV care. Using laboratory test data matched to facility type, we will identify entry to antenatal care to build the cohort, then describe key treatment milestones, including 1) engagement in antenatal care, 2) initiation of ART, 3) HIV viremia, and 4) continuity of HIV care in the postpartum period. Second, we will measure the effect of system-wide factors impacting continuity of care among pregnant women. We will assess policies of expanded treatment access on continuity of care using regression-discontinuity analyses. We then will assess mobility and its effect on continuity of care during and after pregnancy. Third, we will identify individual-level risk factors for loss from HIV care in order to develop targeted interventions to improve engagement in HIV care.

抽象的 我们首次在国家一级，我们建议利用常规收集的实验室数据来开发 在南非有艾滋病毒的孕妇队列的同类，以独特的方式转移 设施。南非是艾滋病毒感染者比其他任何国家都有更多的人的家园，近三分之一 参加产前护理的孕妇患有艾滋病毒。获得抗逆转录病毒疗法（ART）具有 自2004年国家艺术计划开始以来，大大增加了 怀孕和分娩，以及艾滋病毒的母亲传播大大减少。但是，我们的工作有 证明在怀孕期间发起艺术的妇女有辍学的风险越来越高， 特别是在分娩后，导致病毒传播，发病率和死亡率的潜力。很难 评估扩大获得艺术护理访问权的政策的成功，并评估护理的连续性 缺乏国家纵向艾滋病毒护理数据库。此外，未连接设施之间的患者移动 意味着自我转移通常被错误地分类为护理损失。为了解决这一重大缺点，我们的团队在 健康经济学和流行病学办公室（HE2RO）与南非国家卫生合作 2015年实验室服务使用现有的HIV相关实验室数据来创建南非国家 艾滋病毒队列。现在，通过这个五年奖励，我们建议扩大这个成功的项目以常规使用 - 收集了实验室数据，以开发南非艾滋病毒的孕妇队列。我们建议 三个具体目标。首先，我们将开发并验证一个新颖的全国孕妇，可进入 艾滋病毒护理。使用与设施类型相匹配的实验室测试数据，我们将确定到产前护理的进入以构建 队列，然后描述关键治疗里程碑，包括1）参与产前护理，2）启动艺术， 3）HIV病毒血症和4）产后艾滋病毒护理的连续性。第二，我们将衡量 全系统范围的因素影响孕妇的护理连续性。我们将评估扩展的政策 使用回归律分析进行护理连续性的治疗访问。然后，我们将评估流动性 及其对怀孕期间和后护理连续性的影响。第三，我们将确定个人级别的风险因素 艾滋病毒护理的损失是为了制定有针对性的干预措施以改善艾滋病毒护理的参与。