The benefits of antiretroviral therapy (ART) can only be achieved through timely HIV diagnosis, successful linkage to care, and treatment initiation. In South Africa, however, only a fraction of those newly diagnosed with HIV enter HIV care. The period after HIV testing but prior to ART initiation represents a time of very high mortality, fueled by the tuberculosis (TB) epidemic, and therefore a time when improving access to TB screening and HIV care would be of substantial benefit. Though TB is the leading cause death among those with HIV in sub-Saharan Africa, less than one-third of HIV-infected South Africans have been screened for TB. Efforts are urgently needed to implement and evaluate strategies that improve early diagnosis and linkage to HIV and TB care, and to consider such strategies in the context of constrained healthcare resources. We propose two specific aims.
The first aim i s to conduct a randomized controlled trial to establish the efficacy of a health system navigator intervention in improving linkage to HIV and TB care among newly diagnosed HIV-infected outpatients in Durban, South Africa. Using Andersen's model of health service utilization as a theoretical framework, we will provide a health system navigator to help patients identify and overcome barriers to care and we will examine the intersection of contextual and patient-level factors that affect linkage to care.
The second aim i s to evaluate the cost and cost-effectiveness of this intervention for promoting linkage to HIV and TB care at the time of HIV screening. The 2010 Trans-NIH Plan for HIV-related research prioritizes the assessment of outcomes related to TB and HIV care integration on survival, quality of care, and cost, as well as the impact of different approaches for testing, linkage, and retention in care in improving outcomes of HIV disease. The proposed study will address several of these important issues through collaboration among medical, behavioral and cost- effectiveness experts working in the US and the South African province with the highest prevalence of HIV and TB. The results will inform HIV and TB care in South Africa and in other resource-limited settings.
The period after a new HIV diagnosis, but prior to starting antiretroviral therapy, is a time of very high mortality for patients in South Africa, and therefore a time when improving access to HIV care would be of substantial benefit. We propose to study the impact and cost-effectiveness of an intervention to improve linkage to HIV and TB care for newly diagnosed HIV-infected people in Durban, South Africa.
|Drain, Paul K; Losina, Elena; Coleman, Sharon M et al. (2016) Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis. BMC Pulm Med 16:147|
|Ahonkhai, Aimalohi A; Banigbe, Bolanle; Adeola, Juliet et al. (2016) Age Matters: Increased Risk of Inconsistent HIV Care and Viremia Among Adolescents and Young Adults on Antiretroviral Therapy in Nigeria. J Adolesc Health 59:298-304|
|Bassett, Ingrid V; Coleman, Sharon M; Giddy, Janet et al. (2016) Sizanani: A Randomized Trial of Health System Navigators to Improve Linkage to HIV and TB Care in South Africa. J Acquir Immune Defic Syndr 73:154-60|
|O'Laughlin, Kelli N; Rabideau, Dustin J; Kasozi, Julius et al. (2016) Predictors of HIV infection: a prospective HIV screening study in a Ugandan refugee settlement. BMC Infect Dis 16:695|
|Drain, P K; Kleene, J M; Coleman, S M et al. (2015) Prevalence of cryptococcal antigenuria at initial HIV diagnosis in KwaZulu-Natal. HIV Med 16:640-4|
|Siedner, Mark J; Ng, Courtney K; Bassett, Ingrid V et al. (2015) Trends in CD4 count at presentation to care and treatment initiation in sub-Saharan Africa, 2002-2013: a meta-analysis. Clin Infect Dis 60:1120-7|
|Drain, Paul K; Losina, Elena; Coleman, Sharon M et al. (2015) Value of urine lipoarabinomannan grade and second test for optimizing clinic-based screening for HIV-associated pulmonary tuberculosis. J Acquir Immune Defic Syndr 68:274-80|
|Drain, Paul K; Losina, Elena; Coleman, Sharon M et al. (2015) Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa. AIDS Care 27:1231-40|
|Ahonkhai, Aimalohi A; Banigbe, Bolanle; Adeola, Juliet et al. (2015) High rates of unplanned interruptions from HIV care early after antiretroviral therapy initiation in Nigeria. BMC Infect Dis 15:397|
|Katz, Ingrid T; Bogart, Laura M; Cloete, Christie et al. (2015) Understanding HIV-infected patients' experiences with PEPFAR-associated transitions at a Centre of Excellence in KwaZulu Natal, South Africa: a qualitative study. AIDS Care 27:1298-303|
Showing the most recent 10 out of 41 publications