London Sch of Hygiene and Trop Medicine
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Department Name: Epidemiology and Population Health
Abstract
Despite progress in delivering antiretroviral therapy (ART) in Africa, most HIV-infected persons remain undiagnosed, and many enroll in HIV clinics at an advanced stage of disease or do not regularly attend follow-up appointments. This can result in delayed initiation, or poor adherence to ART, which in turn increases mortality and the emergence of drug-resistant HIV strains.
This research will enhance our understanding of how coverage with HIV services has evolved since ART became available. It will evaluate which HIV testing and treatment models encourage early access to HIV care, and investigate how long-life attendance at HIV clinics can be promoted. In particular, the research will explore the relationship between social support, family circumstances and partnership factors and access to HIV services.
The research will be undertaken in rural Tanzania, where serological, demographic and behavioural surveillance has been conducted among 30,000 people since 1994, with anonymous links to HIV clinic data. This integrated system provides a unique opportunity to monitor socio-demographic inequities in HIV service coverage and gain insights into the programmatic and social factors that influence service use. The findings will lead to practical policy recommendations to encourage high levels of early, sustained and equitable access to HIV services.
This research will enhance our understanding of how coverage with HIV services has evolved since ART became available. It will evaluate which HIV testing and treatment models encourage early access to HIV care, and investigate how long-life attendance at HIV clinics can be promoted. In particular, the research will explore the relationship between social support, family circumstances and partnership factors and access to HIV services.
The research will be undertaken in rural Tanzania, where serological, demographic and behavioural surveillance has been conducted among 30,000 people since 1994, with anonymous links to HIV clinic data. This integrated system provides a unique opportunity to monitor socio-demographic inequities in HIV service coverage and gain insights into the programmatic and social factors that influence service use. The findings will lead to practical policy recommendations to encourage high levels of early, sustained and equitable access to HIV services.
Technical Summary
Aim:
The overall aim is to explore the dynamics of access to HIV services including antiretroviral therapy among HIV-infected participants of a Tanzanian community HIV cohort study during the period 2005-2014 in order to inform policies to improve early and sustained access to HIV treatment.
Objectives:
1. To examine trends in rates of access to HIV services (HIV testing, referral, ART, home-based care) among HIV-infected persons following seroconversion and to identify socio-demographic inequities in HIV service use and unmet need for ART.
2. To describe default and mortality rates over time among patients enrolled in the HIV treatment programme, taking into account the influence of time-dependent covariables (e.g CD4 progression) on multi-state outcomes (e.g. ‘pre-treatment monitoring‘ versus ‘on ART‘).
3. To evaluate the role of programme factors (e.g type and place of HIV testing service, place of referral, location of ART clinic) on early and sustained access to HIV treatment.
4. To explore the relationship between social support, family circumstances and partnership factors and timely, sustained access to HIV services.
Design:
Secondary analyses of quantitative data and nested qualitative studies in a community-level HIV cohort study
Methodology:
Data will be used from the Kisesa cohort study which includes 6 rounds of HIV serological surveillance between 1994 and 2009 with detailed surveys on health and sexual behaviour and 23 rounds of demographic surveillance, collecting information on spousal relationships, births, deaths and migration. These data have been anonymously linked to HIV testing, referral and ART data from the start of the national ART programme in early 2005.
Survival analysis will be used to calculate rates of HIV service uptake, mortality and default from each stage of the process of accessing ART following seroconversion, with multi-level modeling used to identify individual-, partnership-, community- and programme-level factors associated with each outcome. ART needs, based on survival time post-HIV infection among seroconverters and age-specific mortality rates among prevalent cases will be compared with ART uptake to assess for trends in socio-demographic inequities in treatment coverage. Qualitative methods will be used to explore the influence of social and programme factors on access and retention in HIV treatment clinics.
Scientific and medical opportunities:
The findings will result in practical policy recommendations regarding the effectiveness of different HIV testing and ART delivery policies, and the potential need for more family-focused interventions to promote timely uptake, equitable access and sustained attendance in HIV programmes in Tanzania and beyond.
The overall aim is to explore the dynamics of access to HIV services including antiretroviral therapy among HIV-infected participants of a Tanzanian community HIV cohort study during the period 2005-2014 in order to inform policies to improve early and sustained access to HIV treatment.
Objectives:
1. To examine trends in rates of access to HIV services (HIV testing, referral, ART, home-based care) among HIV-infected persons following seroconversion and to identify socio-demographic inequities in HIV service use and unmet need for ART.
2. To describe default and mortality rates over time among patients enrolled in the HIV treatment programme, taking into account the influence of time-dependent covariables (e.g CD4 progression) on multi-state outcomes (e.g. ‘pre-treatment monitoring‘ versus ‘on ART‘).
3. To evaluate the role of programme factors (e.g type and place of HIV testing service, place of referral, location of ART clinic) on early and sustained access to HIV treatment.
4. To explore the relationship between social support, family circumstances and partnership factors and timely, sustained access to HIV services.
Design:
Secondary analyses of quantitative data and nested qualitative studies in a community-level HIV cohort study
Methodology:
Data will be used from the Kisesa cohort study which includes 6 rounds of HIV serological surveillance between 1994 and 2009 with detailed surveys on health and sexual behaviour and 23 rounds of demographic surveillance, collecting information on spousal relationships, births, deaths and migration. These data have been anonymously linked to HIV testing, referral and ART data from the start of the national ART programme in early 2005.
Survival analysis will be used to calculate rates of HIV service uptake, mortality and default from each stage of the process of accessing ART following seroconversion, with multi-level modeling used to identify individual-, partnership-, community- and programme-level factors associated with each outcome. ART needs, based on survival time post-HIV infection among seroconverters and age-specific mortality rates among prevalent cases will be compared with ART uptake to assess for trends in socio-demographic inequities in treatment coverage. Qualitative methods will be used to explore the influence of social and programme factors on access and retention in HIV treatment clinics.
Scientific and medical opportunities:
The findings will result in practical policy recommendations regarding the effectiveness of different HIV testing and ART delivery policies, and the potential need for more family-focused interventions to promote timely uptake, equitable access and sustained attendance in HIV programmes in Tanzania and beyond.
