Managed Problem Solving for ART Adherence and HIV Care Retention Delivered by Community Health Workers: A Stepped Wedge Hybrid Type II Effectiveness Implementation Trial

社区卫生工作者提供的针对 ART 依从性和 HIV 护理保留的管理问题解决：阶梯楔形混合 II 型有效性实施试验

• 批准号: 10432088
• 负责人: Rinad Sary Beidas
• 金额: $ 77.67万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10432088
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Area; Back; Behavior Therapy; Behavioral; Benchmarking; Caring; Cities; Client; Clinic; Clinical effectiveness; Communication; Community Health Aides; Consolidated Framework for Implementation Research; Continuity of Patient Care; Counseling; County; Data; Decision Making; Dissemination and Implementation; Elements; Ensure; Epidemic; Ethnic Origin; Evidence based practice; Future; Generations; Goals; HIV; HIV Infections; Health Professional; Health system; Hybrids; Incidence; Individual; Intervention; Interview; Language; Life Experience; Link; Medical Care Team; Outcome Measure; Patients; Persons; Philadelphia; Problem Solving; Process; Professional counselor; Protocols documentation; Public Health; Randomized; Research; Services; Socioeconomic Status; Standardization; Testing; Time; Training; Trust; United States; United States National Institutes of Health; Viral; behavior change; cohort; collaborative approach; design; effectiveness implementation trial; effectiveness outcome; effectiveness testing; experience; falls; health belief; implementation cost; implementation efforts; implementation measures; implementation outcomes; implementation process; implementation research; implementation science; implementation strategy; improved; marginalized population; medication compliance; meetings; member; metropolitan; next generation; primary outcome; retention rate; secondary outcome; skills; treatment as prevention; treatment as usual

Project Summary/Abstract To achieve aspirational goals to end the HIV epidemic (EHE), evidence-based practices (EBPs) to increase viral suppression must be implemented effectively nationally. The Managed Problem Solving (MAPS) behavioral intervention is an EBP for behavior change in people living with HIV (PLWH). To accomplish the goals of this application, we leverage a data-to-care partnership between the Philadelphia Department of Public Health (PDPH) and participating clinics (n = 12), which enhances the sustainability of our approach. We propose that MAPS can be delivered by trained Community Health Workers (CHWs). The use of CHWs to deliver MAPS is justified by their ability to develop trusting relationships with their clients and the need for task shifting in busy clinics. In order to also address retention in care, we will adapt MAPS to also focus on problem solving activities tailored toward retention in care (now termed MAPS+). CHWs will be located in clinics to implement MAPS+ to improve viral suppression and care retention in PLWH. Data-to-care allows for identification of people who are lost to care and link these patients back to care. Currently, medication adherence and retention in HIV care are not targeted in data-to-care so we will build on this approach to facilitate the identification of PLWH who are out of care and not virally suppressed to offer them MAPS+. Our set of implementation strategies include task- shifting the delivery of MAPS+ to CHWs, providing the CHWs training and ongoing support, and increasing communication between the CHWs and medical care team via standardized protocols. We will conduct a hybrid type II effectiveness-implementation trial with a stepped-wedge cluster randomized design in 12 clinics to test MAPS+ compared to usual care using a set of implementation strategies that we believe will best support implementation. Each clinic will be randomized to one of three implementation start times. We will collect baseline (usual care) data from each clinic for 6 months, followed by MAPS+ and our package of implementation strategies for 12 months, in three cohorts of 4 clinics each. Aim 1 will test the effectiveness of MAPS+ on clinical effectiveness outcomes, including viral suppression (primary) and retention (secondary). Aim 2 will examine the effect of the package of implementation strategies on reach. We will also measure implementation cost. Aim 3 will apply a qualitative approach to understand processes, mechanisms, and sustainment of our implementation approach. Our results will guide future efforts to implement behavioral EBPs across the HIV care continuum, consistent with the “treat” pillar of EHE, and move the science of implementation services, consistent with NIH strategic priorities.

项目概要/摘要 为了实现结束艾滋病毒流行 (EHE) 的理想目标，需要采取循证实践 (EBP) 来增加病毒感染 必须在全国范围内有效实施管理问题解决（MAPS）行为。 干预是针对艾滋病毒感染者 (PLWH) 行为改变的 EBP，旨在实现这一目标。 应用程序中，我们利用费城公共卫生部之间的数据护理合作伙伴关系 (PDPH) 和参与诊所 (n = 12)，这增强了我们方法的可持续性。 MAPS 可以由经过培训的社区卫生工作者 (CHW) 提供。使用 CHW 来提供 MAPS。 他们与客户建立信任关系的能力以及在忙碌中转移任务的需要证明了这一点 为了解决护理保留问题，我们将调整 MAPS，使其也专注于解决问题的活动。 专为保留护理而设计（现称为 MAPS+），CHW 将位于诊所，以实施 MAPS+ 改善 PLWH 的病毒抑制和护理保留，以便识别感染者。 目前，艾滋病毒护理中的药物依从性和保留率正在提高。 不是以数据护理为目标，因此我们将以此方法为基础，以方便识别外出的感染者 我们的一系列实施策略包括任务- 将 MAPS+ 的交付转移给社区卫生工作者，为社区卫生工作者提供培训和持续支持，并增加 我们将通过标准化协议在社区卫生工作者和医疗团队之间进行沟通。 II 型有效性实施试验，采用阶梯楔形整群随机设计，在 12 家诊所进行测试 MAPS+ 与使用我们认为最能支持的一组实施策略的常规护理进行比较 每个诊所将被随机分配到三个实施开始时间之一。 每个诊所 6 个月的（常规护理）数据，然后是 MAPS+ 和我们的实施包 目标 1 将测试 MAPS+ 在临床上的有效性，为期 12 个月，分三组，每组 4 个诊所。 有效性结果，包括病毒抑制（主要）和保留（次要），目标 2 将检查病毒抑制（主要）和保留（次要）。 我们还将衡量目标 3 的实施成本。 将采用定性方法来了解我们实施的流程、机制和维持 我们的结果将指导未来在整个艾滋病毒护理过程中实施行为 EBP 的努力， 与 EHE 的“治疗”支柱保持一致，并推动实施服务的科学性，与 NIH 保持一致 战略重点。