LINK4HEALTH: A Combination Strategy for Linkage and Retention, Swaziland

LINK4HEALTH：链接和保留的组合策略，斯威士兰

• 批准号: 8797052
• 负责人: WAFAA M. EL-SADR
• 金额: $ 47.93万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-06-15 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8797052
• 关键词: AIDS prevention; Adult; Africa South of the Sahara; Appointment; Behavioral; Biological Assay; CD4 Lymphocyte Count; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Characteristics; Clinic; Clinical; Collaborations; Communities; Counseling; Country; Disease Progression; Effectiveness; Eligibility Determination; Enrollment; Ensure; Evaluation; Event; Evidence based intervention; Goals; HIV; HIV Seropositivity; Health; High Prevalence; Hospitalization; Human immunodeficiency virus test; Income; Individual; Infection; Infection prevention; Intervention; Link; Morbidity - disease rate; Newly Diagnosed; Outcome; Outcome Study; Patients; Performance; Prevention; Program Effectiveness; Randomized; Reporting; Research; Research Design; Services; Site; Staging; Swaziland; Testing; Time; Visit; antiretroviral therapy; arm; compare effectiveness; cost effective; cost effectiveness; financial incentive; implementation science; improved; innovation; mortality; novel; novel strategies; point of care; programs; randomized trial; scale up; standard of care; transmission process; treatment program

DESCRIPTION (provided by applicant): Linkage of patients from HIV testing to HIV care programs and their retention once enrolled in care are essential to HIV program effectiveness in terms of prevention of HIV-related morbidity and mortality and prevention of HIV transmission. Linkage and retention rates in HIV programs in Sub-Saharan Africa (SSA) are suboptimal, with less than half of patients who test positive successfully linking and remaining in care at 1 year. We propose an implementation science study focused on identifying an effective pragmatic multicomponent strategy to improve linkage and retention of HIV-positive patients in PEPFAR-supported HIV programs in Swaziland. The study design is a two-arm cluster site-randomized trial to compare the effectiveness of a novel combination package of evidence-based interventions, the combination intervention strategy (CIS), compared to standard of care (SOC) on linkage and retention of HIV-positive patients from point of testing to retention in care. CIS will include 1) point of care CD4+count assays at HIV testing sites; 2) accelerated ART initiation for eligible patients; 3) provision of a basic care and prevention package (BCPP); 4) short message service (SMS) reminders for clinic appointments and active tracking of patients who miss visits; and 5) financial incentives for linkage and retention. The primary aim is to evaluate the effectiveness of CIS as compared to SOC on the combined outcome of rapid linkage to HIV care within 1 month and retention in care at 12 months among adults testing positive for HIV. Secondary aims include evaluation of the effectiveness of CIS compared to SOC on each of linkage to HIV; retention in care; time to ART initiation; HIV disease progression (WHO Stage III or IV, hospitalization, CD4+count, and mortality); patient acceptability; association between baseline characteristics and outcomes, and comparison of cost effectiveness with regards to disease progression and infections averted. The proposed study, LINK4HEALTH, is distinguished by several innovations including: the use of a combination of evidence-based interventions targeting multiple barrier types that impede patient linkage and retention in care across different points in the HIV care cascade; utilization of a cluster site-randomized study design to rigorously determine the effectiveness of CIS on a combined outcome of linkage and retention; determination of cost-effectiveness of CIS in terms of disease progression and infections averted; focus on a high-prevalence country in Sub- Saharan Africa; and collaboration with Ministry of Health, PEPFAR, CDC, and other in-country partners. Our approach to the research has the ultimate goal of bridging the know-do gap in terms of identifying a feasible, cost-effective strategy for linkage and retention in HIV care that can be readily integrated into HIV programs and scaled up widely to other PEPFAR-supported and other HIV programs around the world.

描述（由申请人提供）：将患者从艾滋病毒检测与艾滋病毒护理计划联系起来，以及他们一旦参加护理就保留下来，对于艾滋病毒计划在预防艾滋病毒相关发病率和死亡率以及预防艾滋病毒传播方面的有效性至关重要。撒哈拉以南非洲 (SSA) 的艾滋病毒项目的连接率和保留率均不理想，只有不到一半的检测呈阳性的患者在 1 年后成功连接并继续接受护理。我们提议开展一项实施科学研究，重点是确定一种有效、务实的多组成部分策略，以改善艾滋病毒阳性患者在斯威士兰总统防治艾滋病紧急援助计划（PEPFAR）支持的艾滋病毒项目中的联系和保留。该研究设计是一项双臂集群站点随机试验，旨在比较新型循证干预组合方案（联合干预策略（CIS））与标准护理（SOC）在艾滋病毒关联和保留方面的有效性-从检测到保留护理期间呈阳性的患者。 CIS 将包括 1) HIV 检测点的护理点 CD4+ 计数测定； 2) 加速ART启动 对于符合条件的患者； 3) 提供基本护理和预防方案（BCPP）； 4) 短信服务（SMS）提醒就诊，主动追踪漏诊患者； 5) 链接和保留的经济激励。主要目的是评估 CIS 与 SOC 相比，对 HIV 检测呈阳性的成人在 1 个月内快速连接 HIV 护理和 12 个月保留护理的综合结果的有效性。次要目标包括评估 CIS 与 SOC 在与 HIV 的每个联系上的有效性；保留护理；开始 ART 的时间； HIV疾病进展（WHO III或IV期、住院、CD4+计数和死亡率）；患者的可接受性；基线特征和结果之间的关联，以及疾病进展和避免感染方面的成本效益比较。拟议的研究 LINK4HEALTH 具有多项创新，包括：针对多种障碍类型，采用基于证据的干预措施组合，这些障碍类型阻碍了艾滋病毒护理级联中不同点的患者联系和保留护理；利用集群站点随机研究设计来严格确定 CIS 对链接和保留综合结果的有效性；确定 CIS 在疾病进展和避免感染方面的成本效益；重点关注撒哈拉以南非洲的一个高流行国家；以及与卫生部、PEPFAR、CDC 和其他国内合作伙伴的合作。 我们研究方法的最终目标是弥合知识差距，确定一种可行的、具有成本效益的艾滋病毒护理联系和保留策略，该策略可以很容易地纳入艾滋病毒项目，并广泛推广到其他总统紧急救援计划（PEPFAR）。支持的以及世界各地的其他艾滋病毒项目。

项目成果

Cost-effectiveness of a combination strategy to enhance the HIV care continuum in Swaziland: Link4Health.

• DOI: 10.1371/journal.pone.0204245
• 发表时间: 2018
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Stevens ER;Li L;Nucifora KA;Zhou Q;McNairy ML;Gachuhi A;Lamb MR;Nuwagaba-Biribonwoha H;Sahabo R;Okello V;El-Sadr WM;Braithwaite RS
• 通讯作者: Braithwaite RS

The Link4Health study to evaluate the effectiveness of a combination intervention strategy for linkage to and retention in HIV care in Swaziland: protocol for a cluster randomized trial.

• DOI: 10.1186/s13012-015-0291-4
• 发表时间: 2015-07-19
• 期刊: Implementation science : IS
• 作者: McNairy ML;Gachuhi AB;Lamb MR;Nuwagaba-Biribonwoha H;Burke S;Ehrenkranz P;Mazibuko S;Sahabo R;Philip NM;Okello V;El-Sadr WM
• 通讯作者: El-Sadr WM

Low rates of prior HIV testing among HIV-positive adults accessing outpatient services in Eswatini.

在斯威士兰接受门诊服务的艾滋病毒阳性成年人中，事先进行艾滋病毒检测的比例较低。

• DOI: 10.1186/s12981-019-0254-y
• 发表时间: 2019
• 期刊: AIDS research and therapy
• 影响因子: 2.2
• 作者: Nuwagaba-Biribonwoha,Harriet;Wu,Yingfeng;Gachuhi,AverieBaird;McNairy,MargaretL;Madau,Veli;Lamb,Mathew;Mazibuko,Sikhathele;Mnisi,Zandile;Burke,Sean;Philip,Neena;Sahabo,Ruben;ElSadr,WafaaM
• 通讯作者: ElSadr,WafaaM