A mixed methods approach to address multi-level barriers to care for migratory men living with HIV in South Africa

采用混合方法解决照顾南非艾滋病毒携带者移民男性的多层次障碍

基本信息

批准号：
10403224
负责人：
Ingrid T. Katz
金额：
$ 25.46万
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：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10403224
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Affect Africa South of the Sahara Attitude Automobile Driving Behavior Belief Caring Characteristics Client Communities Complex Continuity of Patient Care Country Data Diagnosis Economics Educational workshop Employment Enrollment Epidemic Epidemiology Face Family Future Goals HIV Health Home Human Human immunodeficiency virus test Incidence Individual Internal Migrations Intervention Interview Investigation Link Methods Migrant Modeling Nonmigrant Outcome Participant Pattern Persons Population Population Intervention Population Study Prevalence Prevention Process Protocols documentation Recording of previous events Research Priority Resource-limited setting Risk Services South Africa South African Strategic Planning Structure Testing Thinking Time United States National Institutes of Health Ursidae Family Vulnerable Populations Woman Work barrier to care behavioral economics care seeking design effective intervention epidemiology study experience experimental study health care availability health economics high risk high risk population human centered design improved intervention mapping male medical schools men migration mortality mortality risk multidisciplinary population movement preference recruit rural area service delivery social social structure therapy design therapy development treatment services uptake urban setting

项目摘要

PROJECT SUMMARY The spread of HIV in sub‐Saharan Africa has historically followed population movement within and across country borders. Nowhere is this more evident than in urban centers in South Africa, where the complex interaction between the world’s largest HIV epidemic and a legacy of forced displacement under Apartheid has resulted in a significant population of “internal migrants” (those who move within country) who bear sustained risks across the entire HIV care continuum. The majority are men who migrate to urban centers seeking employment. Not only do migrant men face intrinsic challenges associated with mobility, but they also contend with changing internal and societal constructions of masculinity influencing engagement in care. Given that men with HIV have a two-fold higher mortality rate than women, there is an urgent need to identify interventions that can effectively link and retain migrant men living with HIV to care. The current proposal leverages an established partnership between Harvard Medical School and The Health Economics and Epidemiology Research Office (HE2RO) with the goal of addressing the unique barriers experienced by internal male men living with HIV in South Africa. We will use a sequential mixed- methods design to address the following specific aims: (1) To explore, through semi-structured in-depth interviews, multi-level barriers to engagement and retention in HIV care among internal male migrants living with HIV who are not accessing care (n=30); (2) To elicit preferred HIV treatment and care attributes and service delivery features and explore characteristics driving their selection of preferred scenarios using a Discrete Choice Experiment (n=200); and (3) To co-design an intervention package with our participants and key stakeholders to promote linkage and sustained engagement in HIV care using Design Thinking. This proposal is responsive to PA-19-050, focused on “Engaging Men in HIV Testing, Prevention, and Care,” the new NIH focus on Human Mobility and HIV, and the South African National Strategic Plan for HIV and AIDS, STIs and TB. This R21 has the potential for a significant impact by generating evidence to support a multi-level intervention package to improve uptake and retention in HIV care that is responsive to the unique needs of South African migrant men in a high HIV prevalence urban setting. This multi- disciplinary team has the cross-disciplinary expertise and proven track-record of engaging hard-to-reach populations in the communities needed to execute this study.

项目概要历史上，艾滋病毒在撒哈拉以南非洲地区的传播是随着人口流动而在撒哈拉以南非洲地区传播的。没有哪个地方比南非的城市中心更明显，那里的建筑群。世界上最严重的艾滋病毒流行与种族隔离制度下被迫流离失所的后果之间的相互作用导致大量“国内移民”（在国内流动的人）整个艾滋病毒护理过程中存在持续风险。大多数人是移居城市中心的男性。男性移民不仅面临着与流动性相关的内在挑战，而且他们也面临着就业挑战。还应对不断变化的男性气质影响参与的内部和社会结构鉴于男性艾滋病毒感染者的死亡率是女性的两倍，因此迫切需要提供护理。确定能够有效地将感染艾滋病毒的移民男性联系起来并让他们继续接受护理的干预措施。当前的提案利用了哈佛医学院和 The School 之间已建立的合作伙伴关系卫生经济学和流行病学研究办公室 (HE2RO) 的目标是解决独特的问题我们将使用顺序混合的方法。方法设计要解决以下具体目标：（1）通过半结构化深入探索访谈、国内男性移民参与和保留艾滋病毒护理方面的多层次障碍未获得护理的 HIV 感染者 (n=30)； (2) 找出首选的 HIV 治疗和护理特性，以及服务交付功能，并使用以下方法探索驱动他们选择首选场景的特征离散选择实验（n=200）；以及（3）与参与者共同设计干预方案和主要利益相关者利用设计思维促进艾滋病毒护理的联系和持续参与。该提案响应 PA-19-050，重点是“让男性参与艾滋病毒检测、预防和治疗” 护理”，新的 NIH 重点关注人口流动和艾滋病毒，以及南非国家战略计划该 R21 具有通过提供证据来产生重大影响的潜力。支持多层次的干预措施，以提高艾滋病毒护理的接受度和保留率，并响应南非男性移民在艾滋病毒高发城市环境中的独特需求。学科团队拥有跨学科的专业知识和与难以接触的人接触的良好记录执行这项研究所需的社区人口。