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: 10756591
• 负责人: Kate Clouse
• 金额: $ 15.38万
• 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/10756591
• 关键词: Address; Award; Caring; Continuity of Patient Care; Country; Data; Databases; Drops; Epidemiology; HIV; Health; Health Services Accessibility; Home; Individual; Intervention; Laboratories; Measures; Morbidity - disease rate; Mother-to-child HIV transmission; Movement; Patient Transfer; Patients; Performance; Persons; Policies; Policy Maker; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Research Personnel; Risk; Risk Factors; Services; South Africa; South African; System; Testing; Time; Viremia; Woman; Work; antenatal care; antiretroviral therapy; cohort; health economics; high risk; improved; mortality; novel; post pregnancy; programs; success; tool; 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 我们首次在国家层面提议利用常规收集的实验室数据来开发 南非感染艾滋病毒的孕妇群体以一种独特的方式进行跨国传播 设施。南非的艾滋病毒感染者人数比任何其他国家都多，其中近三分之一的人感染艾滋病毒 接受产前护理的孕妇感染了艾滋病毒。获得抗逆转录病毒治疗（ART）已 自 2004 年国家 ART 计划启动以来，这一数字大幅增加，期间 ART 覆盖率超过 95% 怀孕和分娩以及艾滋病毒母婴传播大大减少。然而，我们的工作已经 证明在怀孕期间开始抗逆转录病毒治疗的女性失去护理的风险更高， 特别是在分娩后，可能导致病毒传播、发病和死亡。很难 评估扩大接受 ART 护理的政策是否成功，并评估护理的连续性，因为 缺乏国家纵向艾滋病毒护理数据库。此外，患者在未连接的设施之间移动 意味着自我转移常常被错误地归类为护理损失。为了解决这个重大缺陷，我们的团队 卫生经济和流行病学办公室 (HE2RO) 与南非国家卫生局合作 2015 年实验室服务部门将利用现有的艾滋病毒相关实验室数据创建南非国家实验室 艾滋病毒队列。现在，通过这个为期五年的奖项，我们建议将这个成功的项目扩大到常规使用- 收集了实验室数据，以开发南非感染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的全国孕妇队列 艾滋病毒护理。使用与设施类型相匹配的实验室测试数据，我们将确定产前护理的准入情况，以建立 队列，然后描述关键的治疗里程碑，包括 1) 参与产前护理，2) 开始 ART， 3) HIV 病毒血症，以及 4) 产后持续的 HIV 护理。其次，我们要衡量一下效果 影响孕妇护理连续性的全系统因素。我们将评估扩大的政策 使用回归-不连续性分析对护理连续性进行治疗。然后我们将评估流动性 及其对怀孕期间和怀孕后护理连续性的影响。第三，我们将识别个人层面的风险因素 艾滋病毒护理造成的损失，以便制定有针对性的干预措施，以提高艾滋病毒护理的参与度。