Pathways to Engagement in HIV-Care for Newly-Diagnosed South Africans

新确诊南非人参与艾滋病毒护理的途径

• 批准号: 7870482
• 负责人: Susie Hoffman
• 金额: $ 59.54万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7870482
• 关键词: AIDS prevention; Address; Adherence; Affect; Africa South of the Sahara; African; Applications Grants; Area; Attention; Behavior; Behavioral; Belief; Caring; Cognitive; Cohort Studies; Communities; Community Health Services; Counseling; Critiques; Data; Decision Making; Developing Countries; Development; Diagnosis; Disclosure; Disease; Educational workshop; Effectiveness; Eligibility Determination; Enrollment; Ensure; Environment; Equipment and supply inventories; Feedback; Foundations; Gender; Goals; HIV; HIV diagnosis; HIV prevention trial; Health; Health Personnel; Health Services; Health Services Accessibility; Health system; Human immunodeficiency virus test; Incidence; Individual; Inequality; International; Intervention; Interview; Knowledge; Learning; Left; Link; Maps; Mental Health; Modality; Motivation; Newly Diagnosed; Outcome; Participant; Pathway interactions; Personal Satisfaction; Persons; Play; Policies; Positioning Attribute; Poverty; Prevalence; Primary Health Care; Process; Professional counselor; Prospective Studies; Provider; Relative (related person); Research; Resources; Risk; Sampling; Screening procedure; Services; Sexual Transmission; Shapes; Social Sciences; South Africa; Staging; Stigmata; Structure; Testing; Time; Woman; Women' s Health; Work; antiretroviral therapy; base; care seeking; care systems; cohort; community organizations; coping; experience; follow-up; improved; innovation; insight; interest; member; men; microbicide; novel; programs; prospective; psychosocial; public health relevance; reproductive; response; scale up; social; social cognition; social organization; social stigma; theories; therapy development; treatment adherence; treatment program

DESCRIPTION (provided by applicant): With the global effort to scale-up treatment programs and increase access to antiretroviral therapy (ART) for HIV+ people in resource-constrained nations, it is vital to understand how people become linked to HIV primary care, as many are entering care too late to benefit from ART. There is now significant momentum to promote HIV testing as a way to increase early enrollment in care, but relatively little attention to address the period immediately after a person receives an HIV+ diagnosis. As most studies of HIV+ individuals have been conducted among those already enrolled in care, there is limited knowledge concerning facilitators of and impediments to enrolling in HIV primary care and care-seeking more generally among those newly-diagnosed. The proposed four-year study, to be conducted in Kwa-Zulu-Natal, South Africa, seeks to fill this gap. Our goals are to determine the most salient influences on enrollment and retention in HIV care (regardless of ART eligibility) that, if addressed, could optimize use of services among newly diagnosed men and women in resource-constrained settings; and to identify collaboratively with key stakeholders promising interventions for further development and testing. The Specific Aims are to (1a) describe the "time to enrollment" cumulative incidence curve, estimate the proportion that enrolls in HIV primary care, and determine the facilitators of and barriers to enrollment and retention in care at multiple levels of influence - social structural (stigma, poverty, gender inequalities), health systems (organization, policies, providers), and individual (mental health, social cognitions, health-related behaviors); (1b) Explore decision-making around disclosure and enrollment/retention in care, and how stigma, poverty, gender inequalities, and health system factors shape these processes, through repeat in-depth interviews with a sub-sample of cohort participants; and (1c) Identify additional critical issues, including need for and use of mental health, reproductive, and other HIV-related ancillary services among newly diagnosed individuals. We will conduct a prospective Cohort Study following 550 newly- diagnosed women and men for eight months with structured assessments at Baseline, 4- and 8-month follow- up, repeat In-Depth Interviews with a subsample of 30, and additional assessment activities to evaluate variables of theoretical interest at the health system and social structural levels, utilizing GPS mapping, an Inventory of Health and Community Services, Media Tracking and Analysis, and structured Counselor Assessments. To advance intervention development, we will review and integrate study findings and discuss promising interventions based on these findings with public officials, non-governmental organization (NGO) members and staff, health care providers, and HIV+ individuals through Interactive Community Feedback sessions; and conduct capacity-building Intervention Development Workshops to enhance agencies' and community members' capacity to rapidly formulate effective, pro-active responses. PUBLIC HEALTH RELEVANCE: To maximize the benefits of expanded HIV testing and optimize the outcomes of ART scale-up with interventions that promote early linkage with primary HIV care and other supportive services, this study aims to determine the most salient influences on enrollment and retention in HIV primary care among newly diagnosed women and men (regardless of ART eligibility) in a context where HIV stigma and poverty are widespread, gender inequality prevails, health services are constrained and policies and programs are in flux, and where HIV care seeking includes the use of both Western and traditional modalities; and to identify collaboratively with community organizations, health care providers, public officials, and HIV+ individuals promising interventions for further development and testing.

描述（由申请人提供）：全球努力扩展治疗计划并增加了在资源约束国家中艾滋病毒+人获得抗逆转录病毒疗法（ART）的机会，重要的是要了解人们如何与HIV初级保健联系起来，因为许多人正在进入护理中，因为许多人无法从艺术中受益。现在，促进艾滋病毒测试是增加早期护理入学率的一种方式，但是在一个人接受HIV+诊断后立即关注该时期的一种方式。由于大多数对艾滋病毒+个体的研究都是在已经参加过护理的人中进行的，因此关于促进者的知识和障碍的知识有限，可以在新近诊断的人中更普遍地参加HIV初级保健和寻求护理。拟议的四年研究将在南非的Kwa-Zulu-Natal进行，试图填补这一空白。我们的目标是确定对艾滋病毒护理的入学和保留率最大的影响（无论艺术资格如何），如果解决的话，可以在资源受限的环境中优化新诊断的男性和女性的服务；并与主要利益相关者合作，有望进行进一步开发和测试。 The Specific Aims are to (1a) describe the "time to enrollment" cumulative incidence curve, estimate the proportion that enrolls in HIV primary care, and determine the facilitators of and barriers to enrollment and retention in care at multiple levels of influence - social structural (stigma, poverty, gender inequalities), health systems (organization, policies, providers), and individual (mental health, social cognitions, health-related行为）； （1B）探讨围绕披露和注册/保留护理的决策，以及通过重复与同类参与者的子样本进行深入的访谈，污名，贫困，性别不平等和卫生系统因素如何影响这些过程； （1C）确定新诊断的个体中精神健康，生殖和其他与HIV相关的辅助服务在内的其他关键问题。我们将在550个新诊断的男女进行八个月后进行一项前瞻性队列研究，并在基线，4个月和8个月的随访中进行结构化评估，重复进行30个子样本的深度访谈，以及其他评估的评估活动，以评估卫生系统和社交级别的理论兴趣变量，并使用gps和社区进行构建，媒体和社区的媒体和媒体，媒体和社区构建，媒体和社区构图，媒体和社区构建，媒体和社区。为了提高干预开发，我们将通过互动社区的反馈会话与公职人员，非政府组织（NGO）成员和员工，医疗保健提供者和HIV+个人讨论研究结果并根据这些发现进行讨论的有希望的干预措施；并举办能力建设干预开发研讨会，以增强机构和社区成员的能力，以迅速提出有效的积极反应。 PUBLIC HEALTH RELEVANCE: To maximize the benefits of expanded HIV testing and optimize the outcomes of ART scale-up with interventions that promote early linkage with primary HIV care and other supportive services, this study aims to determine the most salient influences on enrollment and retention in HIV primary care among newly diagnosed women and men (regardless of ART eligibility) in a context where HIV stigma and poverty are widespread, gender inequality prevails,卫生服务受到限制，政策和计划处于不断变化的状态，寻求艾滋病毒的护理包括使用西方和传统方式；并与社区组织，医疗保健提供者，公职人员和HIV+个人合作，有望进行进一步开发和测试。