Implementation Science of a Data-to-Care Strategy to Improve HIV Continuum and Drug Treatment Outcomes for Out of Care PLWH in Ukraine

数据到护理策略的实施科学，以改善乌克兰非护理艾滋病毒感染者的艾滋病毒连续体和药物治疗结果

• 批准号: 10463563
• 负责人: Kostyantyn Dumchev
• 金额: $ 22.22万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10463563
• 关键词: AIDS/HIV problem; Address; Adherence; Adoption; Affect; Appointment; Area; Caring; Case Management; Characteristics; Client; Climate; Clinic; Clinical; Clinical Data; Clinical Management; Complement; Complex; Consolidated Framework for Implementation Research; Continuity of Patient Care; Cost Analysis; Data; Decision Making; Diagnosis; Drops; Drug Prescriptions; Eastern Europe; Effectiveness; Enrollment; Evaluation; Evidence based intervention; Evidence based practice; Goals; HIV; HIV Seropositivity; HIV diagnosis; Health; Individual; Infrastructure; Injecting drug user; Institutes; International; Intervention; Interview; Laboratories; Medical; Medical Surveillance; Mental Health; National Institute of Drug Abuse; Organizational Policy; Outcome; Participant; Patient Care; Patients; Persons; Pharmacotherapy; Policies; Positioning Attribute; Practice Management; Process; Provider; Psychosocial Assessment and Care; Psychosocial Factor; Public Health; Randomized Clinical Trials; Randomized Controlled Trials; Research; Research Priority; Services; Site; Social Work; System; Test Result; Testing; Treatment outcome; USAID; Ukraine; United States; Viral; Vulnerable Populations; addiction; ancillary care; care outcomes; care providers; care systems; comorbidity; cost effectiveness; data integration; data management; effectiveness evaluation; experience; implementation science; implementation strategy; improved; interest; intravenous drug use; low and middle-income countries; medical information system; medication compliance; multiple data sources; organizational structure; primary outcome; programs; scale up; secondary outcome; service utilization; standard of care; substance abuse treatment; substance use; surveillance data

The goal of this project is to develop and pilot a data-to-care strategy to improve HIV care outcomes among not-in-care PLWH in Ukraine. Data-to-Care (D2C) is a high-impact public health strategy that integrates multiple sources of data such as clinical data from medical information systems, surveillance data, and ongoing case management assessments with clients to identify PLWH who are not in care, engage them in care, and manage the HIV Care Continuum. D2C strategies complement evidence-based practices for HIV care adherence by integrating clinical and case management data at multiple points along the HIV care continuum, using systematic assessments to identify unmet needs such as substance abuse treatment and make appropriate care referrals, and using data to inform practice changes and improve linkage to and retention in care. D2C strategies have been effectively implemented in jurisdictions throughout the United States but are not standard of care in low- and middle-income countries (LMICs) such as Ukraine. In Ukraine, of the approximately 244,000 estimated people living with HIV in Ukraine, only 44% are receiving ART. At least 50% of PLWH in Ukraine acquired HIV though intravenous drug use and are likely to be active people who inject drugs (PWID). ART use rates are particularly low among HIV-positive PWID, with only 38% on ART and 28% virally suppressed. This study’s Specific Aims are: (1) to adapt and develop a D2C implementation strategy for Ukraine; (2) to pilot a randomized clinical trial of a D2C strategy versus standard of care; and (3) to assess the feasibility, acceptability, and implementation-related processes and outcomes of the D2C strategy. We will use a cluster randomized control trial in PEPFAR-designated high priority regions in Ukraine (4 clinical settings and 160 total participants). Main outcomes of interest are: engagement/re-engagement in HIV care, MAT and other ancillary care service; ART initiation/re-initiation; and viral suppression. Outcomes will be assessed at 6 and 12- months post-baseline. Ukraine is well-positioned as a site to identify how D2C strategies can be implemented in LMICs. With the support of international stakeholders such as PEPFAR, the Ukrainian Ministry of Health is actively promoting the use of a medical information system (MIS) at the HIV clinic level. The MIS contains patient-level information on HIV care appointments kept, medication prescriptions, all diagnosed co- morbidities, and clinical and laboratory test results. This information can be mobilized in a D2C strategy that tracks patients through the care continuum, uses data to make decisions about patient care and improve case management practices, attends to psychosocial factors that affect medication adherence (e.g., mental health, addiction), and coordinates the provision of non-clinical social services. This project seeks to develop and test an intervention that influence organizational structure, climate, and culture to promote dissemination and adoption of evidence-based practices; and evaluate the adaptation process, and subsequent effectiveness of evidence-based interventions when implemented in real-world settings.

该项目的目标是开发和试点数据护理策略，以改善艾滋病毒护理结果 乌克兰的非护理 PLWH 数据到护理 (D2C) 是一项高影响力的公共卫生战略，它整合了 多种数据来源，例如来自医疗信息系统的临床数据、监测数据和持续的数据 与客户进行病例管理评估，以确定未接受护理的感染者，让他们接受护理，以及 管理艾滋病毒护理连续体（D2C）策略补充了艾滋病毒护理的循证实践。 通过整合艾滋病毒护理连续过程中多个点的临床和病例管理数据来提高依从性， 使用系统评估来确定未满足的需求，例如药物滥用治疗，并做出 适当的护理转诊，并使用数据来告知实践变化并改善与 D2C 策略已在美国各地的司法管辖区得到有效实施，但仍存在不足。 不是乌克兰等低收入和中等收入国家 (LMIC) 的护理标准。 乌克兰约有 244,000 名艾滋病毒感染者，其中只有 44% 正在接受抗逆转录病毒治疗（至少 50%）。 乌克兰的 PLWH 通过静脉注射毒品感染艾滋病毒，并且很可能是活跃的注射者 HIV 阳性吸毒者中 ART 的使用率特别低，只有 38% 接受 ART，28% 接受 ART。 本研究的具体目标是：(1) 调整和制定 D2C 实施策略 乌克兰；(2) 试行 D2C 策略与护理标准的随机临床试验；以及 (3) 评估 我们将使用 D2C 策略的可行性、可接受性以及实施相关的流程和结果。 在乌克兰 PEPFAR 指定的高优先级地区进行的整群随机对照试验（4 个临床环境和 总共 160 名参与者）。感兴趣的主要成果是：参与/重新参与艾滋病毒护理、MAT 和其他。 辅助护理服务；ART 启动/重新启动和病毒抑制将在 6 点进行评估。 基线后 12 个月，乌克兰处于有利地位，可以确定如何制定 D2C 策略。 在PEPFAR、乌克兰部等国际利益攸关方的支持下，在中低收入国家实施。 卫生部门正在积极推广在艾滋病毒诊所层面使用医疗信息系统 (MIS)。 包含有关艾滋病毒护理预约、药物处方、所有诊断的合并患者的患者级别信息 发病率以及临床和实验室测试结果可以在 D2C 策略中调动。 通过护理连续体跟踪患者，使用数据做出有关患者护理的决策并改善病例 管理实践，关注影响药物依从性的社会心理因素（例如心理健康、 成瘾），并协调非临床社会服务的提供。该项目旨在开发和测试。 影响组织结构、氛围和文化以促进传播和传播的干预措施 采用基于证据的做法；并评估适应过程以及随后的有效性 在现实环境中实施基于证据的干预措施。