Promoting Sustained Viral Suppression Through Implementation of an Adapted Evidence-Informed Low-Barrier Care Model in a System of HIV Primary Care Clinics

通过在艾滋病毒初级保健诊所系统中实施适应性强的循证低门槛护理模式，促进持续的病毒抑制

• 批准号: 10462394
• 负责人: Nanette Dior Benbow
• 金额: $ 89.86万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-02 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10462394
• 关键词: Acute; Address; Adoption; Area; Caring; Case Management; Centers for Population Health; Chicago; Clinic; Complex; Continuity of Patient Care; County; Data; Diagnosis; Diffuse; Discrimination; Effectiveness; Eligibility Determination; Epidemic; Face; Funding; Goals; HIV; Health Services Accessibility; Home; Homelessness; Illinois; Incentives; Individual; Insurance; Lead; Learning; Location; Mental Health; Methods; Modeling; NIH Office of AIDS Research; Outcome; Persons; Phase; Population; Poverty; Preparation; Primary Health Care; Process; Protocols documentation; Public Health; Ramp; Screening procedure; Services; Site; Substance abuse problem; System; Time; Training; United States; Viral; Virus; Visit; Walking; Work; arm; base; budget impact; care coordination; care delivery; care providers; contextual factors; cooking; cost; data enclave; design; disparity reduction; evidence base; experience; follow-up; implementation cost; implementation evaluation; implementation fidelity; implementation outcomes; implementation protocol; implementation research; implementation science; implementation strategy; improved; innovation; interest; outreach; pragmatic trial; retention rate; service delivery; service engagement; social stigma; social structure; substance use; time use; treatment disparity; trial design

PROJECT SUMMARY/ABSTRACT The goal to end the HIV epidemic (EHE) in the United States cannot be achieved if people with HIV (PWH) do not achieve sustained viral suppression (VS). However, more than half of PWH in the US do not receive regular HIV care, due largely to social and structural factors like stigma and discrimination, poverty, and care complexity, as well as conditions like mental health and substance abuse. Additional approaches to care delivery, especially for PWH experiencing compounding barriers, are needed to close the gap in sustained care and VS. Low-barrier care (LBC) is a package of implementation and care engagement strategies developed specifically to address barriers experienced by PWH with complex needs and has been shown to significantly improve VS among this population. The original model of standalone LBC clinics, however, may have challenges in scalability due to feasibility and limited reach to PWH within large areas. In contrast, adapting LBC strategies for integration into existing HIV primary care sites has the potential to facilitate greater use of this promising model of HIV care while also engaging more PWH with unaddressed needs. The overarching goal of this proposal is to evaluate the implementation and effectiveness of adapted LBC strategies in a system of 12 HIV population-centered health homes (PCHHs) funded by the Chicago Department of Public Health (CDPH) using a pragmatic trial design. Guided by the EPIS framework, we will achieve this goal through three specific aims: (1) Facilitate adoption, adaptation, and implementation of LBC strategies by PCHHs using a learning collaborative. Learning collaboratives are widely used, evidence-based implementation strategies. Following best practices, a lead facilitator and subject matter experts will help PCHHs explore and prepare protocols for implementation of LBC strategies while trained practice coaches will provide technical assistance around implementation at each site. CDPH has strong interest in integrating LBC strategies into PCHHs and will both mandate PCHH participation in the learning collaborative and encourage LBC implementation through additional funding. We will assess the process of adoption and implementation of LBC strategies using mixed methods. (2) Evaluate site-specific and system-wide effectiveness of integrated LBC strategies at improving sustained care and VS. Using a single-arm, pre–post trial design, we will assess if rates of retention in care and VS improve in the two years following ramp-up of LBC strategies. We will also examine contextual factors and implementation fidelity using mixed methods to explain variability in outcomes across PCHHs. (3) Assess implementation cost and sustainment of LBC strategies among PCHHs. We will examine implementation costs over time and plans for sustainment using mixed methods. Our proposal directly responds to RFA-AI-21-024 and is consistent with the NIH Office of AIDS Research’s high priority of implementation science to improve HIV service delivery and reduce disparities in treatment. Results from this study will facilitate the use of LBC strategies in new settings to reach PWH with complex needs.

项目概要/摘要 如果艾滋病毒感染者（PWH）在美国结束艾滋病毒流行（EHE）的目标就无法实现 没有实现持续病毒抑制 (VS) 然而，美国一半以上的感染者没有接受治疗。 定期的艾滋病毒护理，主要是由于耻辱和歧视、贫困和护理等社会和结构因素 复杂性，以及心理健康和药物滥用等情况的其他护理提供方法， 特别是对于经历复合障碍的感染者来说，需要缩小持续护理和 VS 方面的差距。 低障碍护理 (LBC) 是制定的一揽子实施和护理参与策略 专门用于解决具有复杂需求的感染者所经历的障碍，并且已被证明可以显着 然而，独立 LBC 诊所的原始模式可能面临挑战。 由于可行性和大范围内的 PWH 范围有限，因此在可扩展性方面存在差异，而采用 LBC 策略。 纳入现有的艾滋病毒初级保健场所有可能促进更多地利用这一有前途的 艾滋病毒护理模式，同时让更多的感染者参与未解决的需求。 该提案旨在评估在 12 个 HIV 系统中调整后的 LBC 策略的有效性和实施情况 以人口为中心的健康之家 (PCHH) 由芝加哥公共卫生部 (CDPH) 资助，使用 在EPIS框架的指导下，我们将通过三个具体目标来实现这一目标： (1) 通过学习促进 PCHH 采用、适应和实施 LBC 策略 协作学习是广泛使用的基于证据的实施策略。 最佳实践、首席协调员和主题专家将帮助 PCHH 探索和准备方案 实施 LBC 策略，同时训练有素的练习教练将提供相关技术援助 CDPH 对将 LBC 战略纳入 PCHH 抱有浓厚的兴趣，并将两者结合起来。 PCHH 参与学习协作并通过额外的方式鼓励 LBC 任务的实施 我们将使用混合方法评估 LBC 战略的采用和实施过程。 (2) 评估综合 LBC 策略在改善特定地点和全系统范围内的有效性 使用单臂、试验前设计，我们将评估护理保留率。 在 LBC 策略升级后的两年内，VS 会有所改善，我们还将研究背景因素。 和实施保真度，使用混合方法来解释 PCHH 之间结果的变异性。 (3) 评估 PCHH 中 LBC 策略的实施成本和维持情况 我们将审查。 随着时间的推移实施成本和使用混合方法的维持计划。 我们的提案直接回应 RFA-AI-21-024，并与 NIH 艾滋病研究办公室的建议一致 高度重视实施科学，以改善艾滋病毒服务提供并减少治疗差异。 这项研究的结果将有助于在新环境中使用 LBC 策略，以满足具有复杂需求的 PWH。