Enhancing HIV assisted contact tracing in Malawi through blended learning: An Implementation Science Study

通过混合学习加强马拉维艾滋病毒辅助接触者追踪：一项实施科学研究

• 批准号: 10405504
• 负责人: Nora Rosenberg
• 金额: $ 51.95万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-23 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10405504
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adopted; Adoption; Africa South of the Sahara; Biological; Caring; Characteristics; Child; Client; Clinical; Cognitive; Collaborations; Contact Tracing; Cost Effectiveness Analysis; Counseling; Country; Data; Decision Trees; Diagnosis; E-learning; Emergency Situation; Epidemic; Feedback; Goals; Guidelines; HIV; HIV Seronegativity; HIV Seropositivity; Health; Health care facility; Human immunodeficiency virus test; Hybrids; Institution; Intervention; Knowledge; Lead; Learning; Link; Malawi; Methods; Modality; Modeling; Outcome; Patient Recruitments; Patients; Persons; Play; Policies; Population; Prevention; Principal Investigator; Problem Solving; Procedures; Process; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Research; Research Design; Research Methodology; Role; Services; Sexual Partners; Structure; Tablets; Technology; Testing; Thinking; Training; Viral; Work; World Health Organization; acceptability and feasibility; arm; base; budget impact; condoms; cost; cost effective; cost effectiveness; digital; disability-adjusted life years; effectiveness outcome; evidence base; field study; health organization; human centered design; implementation outcomes; implementation research; implementation science; implementation strategy; implementation trial; improved; indexing; innovation; insight; interactive feedback; low and middle-income countries; markov model; pilot test; primary outcome; programs; prospective; randomized trial; recruit; secondary outcome; service uptake; skills; social; theories; tool

Project Summary/Abstract Background: Voluntary assisted contact tracing (ACT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention. Malawi, like many countries in sub-Saharan Africa, has adopted ACT policies to support its “95-95-95” targets for HIV testing, treatment, and viral suppression. However, Malawi’s ACT implementation has been poor due to deficits in health worker capacity and clinical coordination. Through preliminary work, our team has 1) developed a set of implementation strategies (theory-based health worker training and continuous quality improvement processes) that address these barriers; 2) packaged these strategies into a blended learning platform that combines digital and face-to-face modalities; and 3) field-tested the package in Malawi with promising preliminary results. In this proposal, the package will be rigorously evaluated in Malawi for implementation, service uptake, and cost-effectiveness outcomes. The overarching hypothesis is that the blended learning ACT package will be feasible and acceptable to implement, build health worker and facility ACT capacity, lead to more contacts tested for HIV, and be cost-effective in the Malawian context. Aims and Methods: Through a two-arm pragmatic cluster randomized implementation trial, the proposed research will address these gaps through three specific aims. Twenty Malawian facilities in two districts will be randomized 1:1 to receive the blended learning implementation package (enhanced) versus standard implementation package (standard) and followed for two years. In the first aim, ACT implementation outcomes will be compared between the enhanced and standard arms. Health worker fidelity to ACT procedures (primary outcome) will be assessed through audio-recorded ACT encounters. Secondary outcomes include facility adoption of the enhanced implementation strategy, as well as health worker feasibility and acceptability. In the second aim, HIV service uptake outcomes will be compared between the enhanced and standard arms. The number of indexes offered ACT, number of contacts elicited, number of contacts tested for HIV (primary outcome), and number of contacts diagnosed as HIV-positive will be compared between the two arms. In the third aim, cost and cost-effectiveness outcomes will be examined. The primary outcome is the incremental cost per disability adjusted life year saved. This will be estimated in the trial population and projected nationally. Team: The team is led by a new and early stage Principal Investigator with ACT expertise. The work is a collaborative endeavor between academic institutions and a large Malawi-based PEPFAR implementing partner with guidance from the Malawi Ministry of Health. The team has expertise in HIV implementation, implementation science, technology-based interventions, qualitative and quantitative research methods, and cost-effectiveness analysis. Impact: This proposal addresses a significant knowledge gap via an innovative research question using a well-designed research plan. The findings will offer important insights and innovations into how to bridge the gap between ACT research and practice, a critical step towards achieving the 95-95-95 targets.

项目摘要/摘要 背景：自愿辅助接触跟踪（ACT）是一种基于证据的方法，可有效识别 需要艾滋病毒治疗和预防的人。与撒哈拉以南非洲许多国家一样，马拉维也 采用了ACT政策，以支持其“ 95-95-95”目标，用于HIV检测，治疗和病毒抑制。然而， 由于卫生工作者的能力和临床协调的定义，马拉维的法案实施不佳。 通过初步工作，我们的团队有1）制定了一套实施策略（基于理论的健康 解决这些障碍的工人培训和持续质量改进过程）； 2）包装这些 将策略纳入结合数字和面对面方式的混合学习平台； 3）经过现场测试 马拉维的包裹具有合理的初步结果。在此提案中，包裹将严格 在马拉维评估，用于实施，服务吸收和成本效益结果。总体 假设是混合学习法案包将是可行的，可以接受，建立健康 工人和设施法案的能力，导致对艾滋病毒的更多联系，并在马拉维人中具有成本效益 语境。目的和方法：通过两臂务实的群集随机实施试验， 拟议的研究将通过三个具体目标解决这些差距。两个地区的二十个马拉维设施 将被随机分为1：1，以接收混合学习实施软件包（增强）与标准 实施软件包（标准），遵循两年。在第一个目标中，ACT实施结果 将在增强臂和标准臂之间进行比较。卫生工作者忠实行动程序（主要） 结果）将通过音频录制的ACT遭遇来评估。次要结果包括设施 采用增强的实施策略，以及卫生工作者的可行性和可接受性。在 第二个目的是，将在增强和标准臂之间比较艾滋病毒服务的吸收结果。 提供的索引数量，提出的联系数量，艾滋病毒测试的联系人数量（主要 结果），将比较两臂之间被诊断为HIV阳性的接触次数。在 将检查第三目，成本和成本效益结果。主要结果是增量成本 每残疾调整了生命年。这将在试验人群中进行估计，并在全国范围内进行预计。 团队：该团队由具有ACT专业知识的新的和早期的首席调查员领导。这项工作是 学术机构与大型的马来人实施合作伙伴之间的合作努力 在马拉维卫生部的指导下。该团队在HIV实施，实施方面具有专业知识 科学，基于技术的干预措施，定性和定量研究方法以及成本效益 分析。影响：该提案通过创新的研究问题解决了一个重大的知识差距 使用精心设计的研究计划。这些发现将为如何桥接提供重要的见解和创新 ACT研究与实践之间的差距，这是实现95-95-95目标的关键一步。