Development and Testing of a Multi-Component Intervention to Support HIV Care Engagement among Patients Receiving Cancer Treatment in Zimbabwe

开发和测试多成分干预措施以支持津巴布韦接受癌症治疗的患者参与艾滋病毒护理

• 批准号: 10700576
• 负责人: Michalina Montano
• 金额: $ 17.47万
• 依托单位: FRED HUTCHINSON CANCER CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700576
• 关键词: AIDS related cancer; Address; Cancer Burden; Cancer Center; Cancer Hospital; Cancer Patient; Caring; Clinical; Clinical Data; Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Development; Development Plans; Disease; Documentation; Dose; Essential worker; Evaluation; Face; Goals; HIV; Health Resources; Healthcare; Healthcare Systems; Hospitals; Income; Interruption; Intervention; Interview; Malawi; Malignant Neoplasms; Measures; Mentors; Methodology; Methods; Morbidity - disease rate; Observational epidemiology; Oncology; Outcome; Participant; Pathway interactions; Patients; Persons; Prevalence; Provider; Qualitative Methods; Quasi-experiment; Questionnaires; Recommendation; Regional Cancer; Reporting; Research; Research Design; Research Methodology; Research Personnel; Resource-limited setting; Resources; Screening for cancer; Services; South Africa; Southern Africa; Subgroup; Techniques; Testing; Time; Training; Treatment outcome; Uganda; United States; Visit; Work; Zimbabwe; antiretroviral therapy; cancer care; cancer diagnosis; cancer prevention; cancer therapy; career development; clinical care; cohort; comorbidity; design; effectiveness/implementation trial; evidence base; evidence based guidelines; experience; global health; implementation framework; implementation science; improved outcome; integrated care; mortality; multi-component intervention; novel strategies; participant enrollment; primary care setting; primary outcome; process improvement; programs; research clinical testing; scale up; screening; secondary outcome; tertiary care; therapy design; time use; treatment center; treatment guidelines; uptake

ABSTRACT In Zimbabwe, the burden of cancer among people with HIV is increasing. Consistent engagement in HIV care is critical to reducing morbidity and mortality among people with HIV in general, and continuation of ART through cancer treatment is essential for people with HIV who have cancer. Because the cancer and HIV care pathways in Zimbabwe are siloed, people with HIV who are attempting to access cancer treatment face unique barriers to engagement in both care continua. While guidelines for treatment of people with HIV and cancer in low- and middle-income settings recommend integration of cancer and HIV care, there is a limited evidence base for how to accomplish this successfully in these settings. There is an important gap in provision of continuous HIV care when people with HIV in Zimbabwe receive a concurrent diagnosis of cancer. The goal of this project is to address that gap by identifying barriers to HIV care engagement specific to people with HIV receiving cancer treatment, and devising, refining, and testing strategies to address those barriers. In Aim 1, we will use questionnaires and routinely collected clinical data to measure disruptions to HIV-related care over time among cancer patients with HIV. In Aim 2A, we will use a mixed-methods approach including questionnaires and in-depth interviews to quantify and contextualize patient-identified barriers and facilitators to consistent engagement in the HIV care continuum during cancer treatment. In Aim 2B, we will first prioritize barriers based on ubiquity and strength of impact, then convene a group of experts and key stakeholders in HIV and cancer healthcare and research to develop a set of strategies to address the highest priority barriers. Strategies will be implemented and refined one at a time using a rapid cycle improvement process, with a final set of 2-3 refined strategies combined and piloted together in Aim 3. In Aim 3, we will measure the acceptability of the package of strategies to patients and hospital staff as our primary outcome. Secondary outcomes will include uptake, experience of barriers and facilitators to HIV care engagement, and disruptions to HIV and cancer care. We will compare secondary outcomes in Aim 3 participants to Aim 1 participants in a quasi-experimental pre-post study design. These aims constitute the mentored research component of the candidate’s career development plan. In parallel with this research, the candidate will pursue additional training in implementation science, qualitative methods, and the design and evaluation of clinical care interventions, supported by an exemplary team of experienced HIV and cancer investigators in the United States and Zimbabwe. The proposed work will address a critical gap in provision of clinical care for people with HIV and cancer in Zimbabwe, and substantially expand Dr. Montaño’s methodological expertise, providing the training, experience and data for her transition to independence.

抽象的 在津巴布韦，艾滋病毒感染者的癌症负担正在增加。 对于总体上降低艾滋病毒感染者的发病率和死亡率以及继续进行抗逆转录病毒疗法至关重要 对于患有癌症的艾滋病毒感染者来说，通过癌症治疗至关重要，因为癌症和艾滋病毒护理。 津巴布韦的治疗途径是孤立的，试图获得癌症治疗的艾滋病毒感染者面临着独特的挑战 参与艾滋病毒和癌症患者治疗指南的障碍。 低收入和中等收入环境建议将癌症和艾滋病毒护理结合起来，但证据有限 如何在这些环境中成功实现这一目标的基础在提供方面存在重大差距。 当津巴布韦艾滋病毒感染者同时诊断出癌症时，提供持续的艾滋病毒护理。 该项目旨在通过确定特定人群参与艾滋病毒护理的障碍来弥补这一差距 艾滋病毒感染者正在接受癌症治疗，并设计、完善和测试策略来解决这些问题 在目标 1 中，我们将使用调查问卷和定期收集的临床数据来衡量对障碍的干扰。 在目标 2A 中，我们将使用混合方法对感染 HIV 的癌症患者进行长期的 HIV 相关护理。 包括问卷调查和深入访谈，以量化和背景化患者识别的障碍和 在目标 2B 中，我们将促进癌症治疗期间持续参与艾滋病毒护理。 首先根据普遍性和影响强度确定障碍的优先顺序，然后召集专家组和关键人员 艾滋病毒和癌症医疗保健和研究领域的利益相关者制定一套战略来解决最高的问题 优先障碍将通过快速周期改进一次实施和完善。 过程，最终将 2-3 个细化策略结合起来并在目标 3 中一起试点。在目标 3 中，我们将 衡量患者和医院工作人员对整套策略的接受程度作为我们的主要结果。 次要成果将包括艾滋病毒护理参与的吸收、障碍和促进因素的经验，以及 我们将比较目标 3 参与者与目标 1 参与者的次要结果。 准实验性前期研究设计的参与者这些目标构成了指导性研究。 候选人职业发展计划的一部分与这项研究同时进行。 科学、定性方法以及临床设计和评估方面的额外培训实施 护理干预措施，由美国经验丰富的艾滋病毒和癌症研究人员组成的模范团队提供支持 各国和津巴布韦。拟议的工作将解决为患者提供临床护理方面的关键差距。 津巴布韦的艾滋病毒和癌症，并大幅扩展 Montaño 博士的方法学专业知识，提供 为她过渡到独立提供的培训、经验和数据。