A sequential, adaptive model of differentiated service delivery to reach persons living with HIV who are lost-to-follow-up or who have detectable viral load

一种连续的、适应性的差异化服务提供模式，旨在覆盖失访或病毒载量可检测的艾滋病毒感染者

• 批准号: 10524390
• 负责人: Ruanne Vanessa Barnabas
• 金额: $ 4万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-16 至 2024-06-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10524390
• 关键词: Biometry; Blood; COVID-19; COVID-19 pandemic; Caring; Client; Clinic; Commuting; Data; Decentralization; Environmental Health; Environmental Impact; Epidemiologic Methods; Fee-for-Service Plans; Goals; HIV; Health; Health Services; Health Services Accessibility; Home; Human; Individual; Intervention; Medicine; Modeling; Monitor; Patients; Persons; Pilot Projects; Provider; Randomized Controlled Trials; Research; Rural Community; Science; Services; South Africa; Transportation; Universities; Viral; Viral Load result; Virus Replication; Washington; antiretroviral therapy; base; budget impact; cost; cost effective; cost effectiveness; cost estimate; follow-up; health care delivery; health care service; health economics; novel strategies; pandemic disease; service delivery; standard of care; therapy adherence

ABSTRACT While there is no effective cure for HIV, taking HIV medicine called antiretroviral therapy (ART) can reduce the amount of HIV in the blood of people with HIV to almost complete suppression of viral replication and undetectable viral load. In South Africa, the vast majority of ART is dispensed through clinics. The COVID-19 pandemic demonstrated how disruptions to health care services can impact individuals' access to care. However, novel approaches to health care delivery have allowed providers to continue to meet the needs of their patients throughout the pandemic. Specifically for HIV care, home delivery of ART has the potential to both increase coverage for decentralized ART delivery in rural communities and be cost-effective in comparison to clinic-based ART refills. In the pilot Deliver Health Study, we demonstrated that home delivery and monitoring of ART, including a client fee for service, increased viral suppression compared to standard clinic-based services. Furthermore, home delivery of ART would likely reduce the number of people commuting to clinics with personal vehicles and public transportation, decrease overall emissions, and have a positive impact on environmental health. The goal of the proposed Diversity Supplement is to compare the cost, cost-effectiveness, environmental impact, and COVID-19 service disruptions of two different ART resupply mechanisms on viral suppression in KwaZulu-Natal, South Africa. This project will utilize data from a pilot study conducted in 2020, the Deliver Health Study, to inform the ongoing sequential multiple assignment randomized controlled trial of scalable interventions for antiretroviral therapy delivery (SMART ART) in South Africa co-led by Dr. Ruanne Barnabas at the University of Washington in Seattle and Dr. Alastair van Heerden at the Human Sciences Research Council in South Africa.

抽象的 虽然没有有效治愈艾滋病毒的治疗方法，但服用称为抗逆转录病毒疗法（ART）的艾滋病毒药物可以减少 艾滋病毒患者血液中的艾滋病毒量几乎完全抑制病毒复制和 无法检测到的病毒负荷。在南非，绝大多数艺术是通过诊所分配的。 COVID-19 大流行证明了对医疗服务的破坏如何影响个人获得护理的机会。然而， 新颖的医疗保健提供方法使提供者能够继续满足患者的需求 在整个大流行中。专门用于艾滋病毒护理，送货上门的艺术品有可能增加 与诊所相比 艺术补充。在飞行员提供健康研究中，我们证明了对艺术的送货上门和监视， 包括服务客户费用，与标准诊所服务相比，病毒抑制增加。 此外，艺术品的送货上门可能会减少以个人的方式通勤到诊所的人数 车辆和公共交通工具，减少整体排放，并对环境产生积极影响 健康。提议的多样性补充的目的是比较成本，成本效益，环境 影响，以及两种不同的艺术补给机制对病毒抑制的服务中断 夸祖鲁 - 纳塔尔，南非。该项目将利用2020年进行的试点研究中的数据，交付健康 研究，以告知正在进行的顺序多重分配随机对照试验的可扩展干预措施 南非由大学的Ruanne Barnabas博士共同主持的抗逆转录病毒疗法（智能艺术） 西雅图的华盛顿和南非人类科学研究委员会的Alastair Van Heerden博士。