Implementation Research to Enhance Equity- Focused HIV Prevention in New York City

加强纽约市以公平为重点的艾滋病毒预防的实施研究

• 批准号: 10460103
• 负责人: Sarit A Golub
• 金额: $ 135.86万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10460103
• 关键词: Implementation; Research; Enhance; Equity; Focused

7.1. PROJECT SUMMARY/ABSTRACT -- CORE Project One of the fundamental challenges to effective implementation of HIV prevention interventions is the engagement of clients who are eligible for and would benefit most from them. This Core Project is focused on this critical implementation problem: the need to develop and test novel implementation strategies that increase engagement, uptake, and sustainment of proven HIV prevention interventions, including rapid testing, PrEP/PEP, and iART. Based on a review of the research literature and data collected directly from community members in their EHE high priority jurisdictions, the New York City Health Department (NYC HD) has identified three core determinants of this HIV prevention implementation problem: (1) clients’ anticipated and experienced stigma and discrimination limit acceptability and uptake; (2) providers’ implicit and explicit bias limit offers and dissemination; and (3) systemic emphasis on siloed services and risk-based eligibility limits access and availability. In response to this problem, the NYC HD has chosen an implementation strategy called the GOALS Approach to Sexual Health, which is designed to: a) universalize and normalize HIV prevention conversations and interventions; and b) disseminate a client-centered, gender-affirming, non-discriminating, anti-stigmatizing and trauma-informed approach to sexual history and HIV prevention conversations. This Core Project uses a two-phase cluster-randomized, stepped-wedge implementation trial to evaluate adoption of the implementation strategy in 20 agencies funded by the NYC HD. Based on an implementation science model, we will examine outcomes at three levels: a) implementation outcomes (e.g., rates of HIV testing, PrEP uptake, immediate linkage of newly diagnosed patients to care); b) service outcomes (e.g., equitable distribution of HIV prevention interventions to highest priority populations); and c) patient outcomes (e.g., impact on city-wide HIV incidence, engagement in care, and viral suppression). Secondary analysis will also be conducted on hypothesized mechanisms (i.e., mediators) as defined in the program’s logic model, including dimensions of provider competence and patients’ experience. Model fidelity data will be collected on enactment of the GOALS Approach implementation strategy by the NYC HD, and its ability to successfully implement the strategy at each of the individual agencies. Finally, qualitative data will be collected to assess barriers and facilitators to implementation at both the health department and agency levels to inform future adaptation and dissemination of the implementation strategy. 7.2. PROJECT SUMMARY/ABSTRACT -- COLLABORATIVE Project One of the most persistent challenges in health care provision is quality. It is often easy to determine which or how many services are being provided to clients by a given agency or program, but it is far more difficult to determine how well these services are being delivered, or what aspects of service delivery have the greatest impact on outcomes. This Collaborative Project is based on the scientific premise that quality can be defined, measured, and supported by a re-envisioning of health department contract practices, and that an implementation science approach can evaluate this innovative strategy and identify its strengths and weaknesses for broader dissemination. In this Collaborative Project, we address the persistent problem of quality through: a) an implementation strategy that defines quality in HIV prevention services and operationalizes a logic model through which higher quality services will address known barriers and inequities at the community-, system-, and client-levels; b) a data collection and quality improvement and management (QIM) strategy that focuses on quality and quality metrics as incentive-based deliverables in HIV prevention contracts; c) a training and technical support system that works with agencies to identify challenges to quality service provision and supports them to identify and enact approaches to address those challenges; and d) a collaborative research design that measures initiation, adoption, and sustainment of each component of this implementation strategy, and applies a programmatic logic model to examine the impact of each component on hypothesized determinants, mechanisms, and outcomes. The New York City Health Department (NYC HD) has selected a Quality-Based Financing (QBF) model to fund its HIV prevention contracts (in contrast to a traditional fee-for-service model) as an implementation strategy to decrease inequities in access, utilization, and outcomes for HIV prevention services, and to equitably decrease the HIV incidence among NYC’s highest priority populations. This Collaborative Project has four main objectives: (1) conduct an interrupted time series (ITS) analysis to evaluate the impact of implementing the QBF model; (2) qualitatively explore factors that potentially explain differences in successful implementation of QBF across different agencies; (3) Identify factors significantly associated with differential effectiveness of the QBF model using longitudinal multiple regression analysis; and (4) Measure model fidelity and monitor QBF implementation at the level of the health department and funded agencies.

7.1. 项目概要/摘要——核心项目 有效实施艾滋病毒预防干预措施的基本挑战之一是 该核心项目的重点是吸引有资格参与并从中受益最大的客户。 这个关键的实施问题：需要开发和测试新的实施策略，以增加 参与、采用和维持经过验证的艾滋病毒预防干预措施，包括快速检测、 PrEP/PEP 和 iART 基于对研究文献和直接从社区收集的数据的回顾。 纽约市卫生局 (NYC HD) 已确定其 EHE 高优先管辖区的成员 艾滋病毒预防实施问题的三个核心决定因素：（1）客户的预期和经验 耻辱和歧视限制了可接受性和接受度；(2) 提供者隐性和显性的偏见限制了报价和服务 传播；(3) 系统性地强调孤立的服务和基于风险的资格限制了访问和 为了解决这个问题，纽约市房屋署选择了一种名为“目标”的实施策略。 性健康方法，旨在：a) 普及艾滋病毒预防对话并使之正常化 和干预措施；b) 传播以客户为中心、性别肯定、非歧视、反污名化的理念 该核心项目采用基于创伤的方法来预防性史和艾滋病毒对话。 两阶段整群随机、阶梯式楔形实施试验到采用实施评估 我们将根据实施科学模型对 20 个由 NYC HD 资助的机构实施的战略进行研究。 三个层面的成果： a) 实施成果（例如，HIV 检测率、PrEP 采用率、直接联系 新诊断的患者接受护理）；b) 服务成果（例如，艾滋病毒预防的公平分配） 对最优先人群的干预措施）；和 c) 患者结果（例如对全市艾滋病毒发病率的影响， 还将对捕获的病毒进行二次分析。 程序逻辑模型中定义的机制（即中介者），包括提供者的维度 将在制定目标方法时收集模型保真度数据。 纽约市 HD 的实施策略，以及其在每个州成功实施该策略的能力 最后，将收集定性数据来评估实施的障碍和促进因素。 在卫生部门和机构层面为未来的调整和传播提供信息 实施策略。 7.2. 项目摘要/摘要——合作项目 医疗保健提供中最持久的挑战之一是质量，通常很容易确定哪个或哪个。 某个机构或计划向客户提供了多少服务，但要了解这一点要困难得多 确定这些服务的交付情况，或者服务交付的哪些方面效果最好 该合作项目基于质量可以定义的科学前提， 通过重新设想卫生部门合同实践来衡量和支持，并且 实施科学方法可以评估这一创新战略并确定其优势和 在这个合作项目中，我们解决了长期存在的问题 质量通过： a) 定义艾滋病毒预防服务质量的实施战略和 实施逻辑模型，通过该模型更高质量的服务将解决已知的障碍和不平等 b) 社区、系统和客户层面的数据收集以及质量改进和管理； (QIM) 战略，重点关注质量和质量指标，作为艾滋病毒预防中基于激励的可交付成果 c) 与各机构合作识别质量挑战的培训和技术支持系统； 提供服务并支持他们确定和制定应对这些挑战的方法；以及 协作研究设计，衡量该项目每个组成部分的启动、采用和维持 实施策略，并应用编程逻辑模型来检查每个组件对 阻碍因素、机制和结果 纽约市卫生局 (NYC HD) 选择了基于质量的融资 (QBF) 模式为其艾滋病毒预防合同提供资金（与 传统的按服务付费模式）作为减少获取、利用、 艾滋病毒预防服务的成果和结果，并公平地降低纽约市最高人口中的艾滋病毒发病率 该合作项目有四个主要目标：(1) 进行中断时间。 系列（ITS）分析来评估实施QBF模型的影响（2）定性探索因素； (3) 确定不同机构成功实施 QBF 的潜在差异； 与使用纵向多重的 QBF 模型的差异有效性显着相关的因素 回归分析；(4) 测量模型保真度并监控健康层面的 QBF 实施情况 部门和资助机构。