South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact

南非新的中央慢性药物配发和分配计划：评估诊所、患者和社区的影响

基本信息

批准号：
9751392
负责人：
Ingrid Valerie Bassett
金额：
$ 67.63万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-26 至 2023-05-31
项目状态：
已结题

项目摘要

Project Summary Achieving the UNAIDS 90-90-90 target by 2020 in sub-Saharan Africa will require innovative solutions to meet the increasing demands placed on public health care facilities. With ART coverage in sub-Saharan Africa hovering around 50%, health systems face the dual challenge of increasing HIV testing and ART enrollment for those not yet in care and continuing to provide treatment to the millions of people already on ART. Community- based ART delivery is a potential strategy for maintaining long-term virologic suppression and retention in HIV care. South Africa’s new Central Chronic Medicine Dispensing and Distribution (CCMDD) program allows clinically stable patients to choose from a list of community pick-up points (e.g., private pharmacies, schools, churches) to access ART and therefore has the potential to offer more convenient services to patients and to decompress health facilities. The current proposal leverages this national policy change to assess the impact of this large scale service delivery intervention at the patient-, clinic-, and community-level over time in the high-density settlement of Umlazi in Durban, South Africa. Using a mixed-methods approach that incorporates the Practical, Robust Implementation and Sustainability Model (PRISM), we will comprehensively evaluate the impact of CCMDD at all 10 public sector clinics in Umlazi through the following specific aims: 1) To prospectively assess patient uptake of CCMDD and patient factors associated with favorable early clinical outcomes for CCMDD enrollees and to compare outcomes with non-enrollees; 2) To evaluate facilitators of and barriers to adoption of CCMDD by patients, clinic staff, and administrators using qualitative methods, and 3) To evaluate virologic suppression over time across all 10 public sector clinics in Umlazi using programmatic electronic health record data. This proposal is motivated by PA-17-182 to better understand system-level interventions using implementation science, which may increase the number of people consistently engaged in HIV care. We have played a major role for over a decade implementing and evaluating interventions along the HIV care continuum in South Africa and are well-positioned to evaluate the impact of this important policy change. Our results will inform clinical leaders and policymakers in high HIV prevalence settings developing community ART delivery systems that will enable life-long therapy for millions of people living with HIV. This research has the potential to change clinical practice throughout sub-Saharan Africa, where innovative and efficient approaches to long-term community-based HIV treatment delivery are urgently needed.

项目摘要到2020年，在撒哈拉以南非洲实现UNAIDS 90-90-90目标，将需要创新的解决方案来满足对公共卫生保健机构的需求越来越大。撒哈拉以南非洲的艺术报道悬而未决的卫生系统面临着增加艾滋病毒测试和艺术入学率的双重挑战那些尚未受到照顾的人，并继续为已经在艺术上的数百万人提供治疗。社区- 基于艺术的交付是维持长期病毒学抑制和艾滋病毒保留的潜在策略关心。南非新的中央慢性医学分配和分配（CCMDD）计划允许临床稳定的患者可以从社区接送点列表中进行选择（例如，私人药房，学校，教堂）可以进入艺术，因此有可能为患者提供更便捷的服务和减压医疗设施。当前的提案利用本国政策变更来评估影响随着时间的流逝，这种大规模服务提供干预措施 Umlazi在南非德班的高密度定居点。使用合并的混合方法方法实用，强大的实施和可持续性模型（PRISM），我们将全面评估 CCMDD通过以下特定目的在Umlazi的所有10个公共部门诊所的影响： 1）预期评估患者的CCMDD摄取和与早期有利的患者因素 CCMDD注册的临床结果并将结果与非报名的结果进行比较； 2）评估使用定性的患者，诊所工作人员和管理人员采用CCMDD的促进者和障碍方法和3）使用Umlazi的所有10个公共部门诊所中评估病毒学抑制编程电子健康记录数据。 PA-17-182激发了该建议，以更好地了解实施的系统级干预措施科学可能会增加从事艾滋病毒护理的人数。我们扮演了专业在南非的艾滋病毒护理连续体中实施和评估干预措施十多年来的作用并具有良好的位置，以评估这一重要政策变化的影响。我们的结果将为临床提供信息高艾滋病毒流行率的领导者和政策制定者开发社区艺术交付系统将为数百万艾滋病毒感染者提供终身治疗。这项研究有可能改变整个撒哈拉以南非洲的临床实践，长期创新有效的方法迫切需要基于社区的艾滋病毒治疗。