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.

项目摘要/摘要 如果艾滋病毒患者（PWH），无法实现结束美国艾滋病毒流行病（EHE）的目标 请勿实现持续的病毒抑制（VS）。但是，在美国，超过一半的PWH没有收到 定期的艾滋病毒护理，主要是由于污名和歧视，贫穷和关怀等社会和结构性因素 复杂性以及精神健康和药物滥用等条件。其他护理交付的方法， 尤其是对于经历复合障碍的PWH，才能缩小持续护理和VS的差距。 低级级护理（LBC）是制定的实施和护理参与策略的一揽子计划 特别是针对PWH经历的障碍，并已显示出明显的 改善该人群中的VS。但是，独立LBC诊所的原始模型可能面临挑战 由于可行性而导致的可伸缩性和在大面积内到达PWH的范围有限。相反，调整LBC策略 集成到现有的HIV初级保健网站中有可能促进更多地利用这一诺言 艾滋病毒护理模型，同时还可以使更多的PWH满足需求。总体目标 建议是评估在12 HIV系统中适应的LBC策略的实施和有效性 由芝加哥公共卫生部（CDPH）资助的以人口为中心的卫生署（PCHHS）使用 务实的试验设计。在EPIS框架的指导下，我们将通过三个特定目标实现这一目标： （1）促进PCHHS使用学习的采用，适应和实施LBC策略 协作。学习协作措施是广泛使用的，基于证据的实施策略。下列的 最佳实践，主要促进者和主题专家将帮助PCHHS探索和准备协议 在训练有素的实践教练的同时，实施LBC策略将提供技术帮助 在每个站点上实现。 CDPH对将LBC策略纳入PCHH有很大兴趣 授权PCHH参与学习合作，并通过其他 资金。我们将使用混合方法评估LBC策略的采用和实施过程。 （2）评估综合LBC策略改进地点特异性和全系统范围的有效性 持续的护理和VS。使用单臂前试验设计，我们将评估保留率是否保留率 在LBC策略加速后的两年中，VS在两年内有所改善。我们还将研究上下文因素 并使用混合方法来解释PCHH的结果的可变性。 （3）评估PCHHS中LBC策略的实施成本和维持。我们将检查 随着时间的推移，实施成本和使用混合方法的维持计划。 我们的建议直接响应RFA-AI-21-024，并且与NIH AIDS Research的办公室一致 实施科学的高优先级以改善艾滋病毒服务的提供并减少治疗中的分布。 这项研究的结果将有助于在新环境中使用LBC策略，以达到满足复杂需求的PWH。