Activity 2.2.2: Develop your research question - PPS&Q

Components of the Problem Statement
The broad research problem	The problem here is that patients are not being retained in HIV care. The loss to follow-up (LTFU) of people living with HIV (PLHIV) who are receiving antiretroviral therapy (ART) has negative consequences on their treatment outcomes, the risk of transmission to uninfected partners, and drug-resistant strains of HIV. There are significant delays in the current methods to trace HIV+ patients on antiretroviral therapy (ART) who are lost-to-follow-up (LTFU).
The knowledge gap	there is no current academic literature about using predictive models in SA to determine the feasibility of it. There is a lack of research on early tracing methods that can substantially reduce LTFU (Bershetyn et al., 2017).
The context of the study (People, place, time)	People living with HIV (PLHIV), who are in antiretroviral therapy (ART) and have been identified as LTFU by ART programmes and cohort studies in South Africa.
The rationale	The prioritization of successfully tracing LTFU patients early can substantially reduce attrition, and its associated health outcomes and more accurately monitor the success of ART programmes.
*Conceptual frameworks	Through individual-level patient data - such as time on ART, time since last clinic visit, the WHO clinical stage of HIV progression of patients initiated on ART, age, sex, and location - it is possible to predict the risk of attrition (including loss to follow-up, silent transfers, patients still in care, and mortality) of PLHIV on ART. The timely identification of individuals at risk of attrition is based on the predictive model outcomes. Variables: Time on ART, time since the last clinic visit, WHO clinical stage at ART initiation, age, sex, and location. Association with Attrition: Examination of how these variables correlate with attrition, including silent transfers and discontinuation of ART.
Components of the Purpose Statement
The purpose of this research is to… OR This study aims to…	The purpose of this research is to explore the feasibility of using individual patient data/characteristics to develop a predictive analysis model that will be able to estimate the probability of attrition (LTFU) to enable early tracing.
*Methodology	Quantitative: To use statistical methods for predictive modelling, assessing the accuracy of the predictive model to predict attrition and examine associations between individual-level factors (time on ART, time since last clinic visit, etc.) and attrition. Qualitative: A survey to collect insights from healthcare workers about their perception of factors related to attrition and compare the factors identified in this survey with the results from the predictive model.
Research Questions
Main research question	How can predictive analysis, using individual patient data, enable early tracing to determine the risk of attrition of PLHIV in South Africa?
Subsidiary research questions	What individual-level factors (time on ART, time since last clinic visit, WHO clinical stage, age, sex, etc.) are statistically significant predictors of loss to follow-up, silent transfers, patients still in care, and mortality? What are the patterns in individual-level factors associated with loss to follow-up, silent transfers, patients still in care, and mortality?