Implementation Research to Enhance Equity- Focused HIV Prevention in New York City

加强纽约市以公平为重点的艾滋病毒预防的实施研究

• 批准号: 10645068
• 负责人: Sarit A Golub
• 金额: $ 135.88万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10645068
• 关键词: Implementation; Research; Enhance; Equity; Focused

7.1. PROJECT SUMMARY/ABSTRACT -- CORE Project One of the fundamental challenges to effective implementation of HIV prevention interventions is the engagement of clients who are eligible for and would benefit most from them. This Core Project is focused on this critical implementation problem: the need to develop and test novel implementation strategies that increase engagement, uptake, and sustainment of proven HIV prevention interventions, including rapid testing, PrEP/PEP, and iART. Based on a review of the research literature and data collected directly from community members in their EHE high priority jurisdictions, the New York City Health Department (NYC HD) has identified three core determinants of this HIV prevention implementation problem: (1) clients’ anticipated and experienced stigma and discrimination limit acceptability and uptake; (2) providers’ implicit and explicit bias limit offers and dissemination; and (3) systemic emphasis on siloed services and risk-based eligibility limits access and availability. In response to this problem, the NYC HD has chosen an implementation strategy called the GOALS Approach to Sexual Health, which is designed to: a) universalize and normalize HIV prevention conversations and interventions; and b) disseminate a client-centered, gender-affirming, non-discriminating, anti-stigmatizing and trauma-informed approach to sexual history and HIV prevention conversations. This Core Project uses a two-phase cluster-randomized, stepped-wedge implementation trial to evaluate adoption of the implementation strategy in 20 agencies funded by the NYC HD. Based on an implementation science model, we will examine outcomes at three levels: a) implementation outcomes (e.g., rates of HIV testing, PrEP uptake, immediate linkage of newly diagnosed patients to care); b) service outcomes (e.g., equitable distribution of HIV prevention interventions to highest priority populations); and c) patient outcomes (e.g., impact on city-wide HIV incidence, engagement in care, and viral suppression). Secondary analysis will also be conducted on hypothesized mechanisms (i.e., mediators) as defined in the program’s logic model, including dimensions of provider competence and patients’ experience. Model fidelity data will be collected on enactment of the GOALS Approach implementation strategy by the NYC HD, and its ability to successfully implement the strategy at each of the individual agencies. Finally, qualitative data will be collected to assess barriers and facilitators to implementation at both the health department and agency levels to inform future adaptation and dissemination of the implementation strategy. 7.2. PROJECT SUMMARY/ABSTRACT -- COLLABORATIVE Project One of the most persistent challenges in health care provision is quality. It is often easy to determine which or how many services are being provided to clients by a given agency or program, but it is far more difficult to determine how well these services are being delivered, or what aspects of service delivery have the greatest impact on outcomes. This Collaborative Project is based on the scientific premise that quality can be defined, measured, and supported by a re-envisioning of health department contract practices, and that an implementation science approach can evaluate this innovative strategy and identify its strengths and weaknesses for broader dissemination. In this Collaborative Project, we address the persistent problem of quality through: a) an implementation strategy that defines quality in HIV prevention services and operationalizes a logic model through which higher quality services will address known barriers and inequities at the community-, system-, and client-levels; b) a data collection and quality improvement and management (QIM) strategy that focuses on quality and quality metrics as incentive-based deliverables in HIV prevention contracts; c) a training and technical support system that works with agencies to identify challenges to quality service provision and supports them to identify and enact approaches to address those challenges; and d) a collaborative research design that measures initiation, adoption, and sustainment of each component of this implementation strategy, and applies a programmatic logic model to examine the impact of each component on hypothesized determinants, mechanisms, and outcomes. The New York City Health Department (NYC HD) has selected a Quality-Based Financing (QBF) model to fund its HIV prevention contracts (in contrast to a traditional fee-for-service model) as an implementation strategy to decrease inequities in access, utilization, and outcomes for HIV prevention services, and to equitably decrease the HIV incidence among NYC’s highest priority populations. This Collaborative Project has four main objectives: (1) conduct an interrupted time series (ITS) analysis to evaluate the impact of implementing the QBF model; (2) qualitatively explore factors that potentially explain differences in successful implementation of QBF across different agencies; (3) Identify factors significantly associated with differential effectiveness of the QBF model using longitudinal multiple regression analysis; and (4) Measure model fidelity and monitor QBF implementation at the level of the health department and funded agencies.

7.1。项目摘要/摘要 - 核心项目 有效实施HIV预防干预措施的基本挑战之一是 有资格并将从中受益最大的客户参与。这个核心项目的重点是 这个关键的实施问题：开发和测试增加的新型实施策略的需求 参与，摄取和维持经过验证的艾滋病毒预防干预措施，包括快速测试， 准备/PEP和IART。基于对直接从社区收集的研究文献和数据的回顾 纽约市卫生局（NYC HD）的高优先级司法管辖区的成员已确定 三个核心确定了这种预防艾滋病毒的实施问题：（1）客户的预期和经验丰富 污名和歧视限制可接受性和吸收； （2）提供商的隐式和明确偏见限制提供的和 传播； （3）系统地强调孤立的服务和基于风险的资格限制访问权限和 可用性。为了解决这个问题，纽约市HD选择了一种称为目标的实施策略 性健康方法旨在：a）普遍化和标准化艾滋病毒预防对话 和干预措施； b）传播以客户为中心的，性别肯定，无歧视的反耻辱 以及针对性史和预防艾滋病毒的对话的创伤方法。这个核心项目使用 两阶段群集随机，阶梯式边缘实施试验，以评估实施的采用 由NYC HD资助的20个机构的战略。基于实施科学模型，我们将研究 在三个级别的结果：a）实施结果（例如，艾滋病毒测试率，预备力，立即联系 新诊断的患者的护理）； b）服务成果（例如，预防艾滋病毒的公平分配 干预最高优先级人群）； c）患者结果（例如，对全市艾滋病毒事件的影响， 参与护理和病毒抑制）。次级分析也将在假设的 该计划的逻辑模型中定义的机制（即调解人），包括提供商的尺寸 能力和患者的经验。模型保真度数据将根据颁布目标方法收集 NYC HD实施策略及其成功实施该策略在每个的能力 个别机构。最后，将收集定性数据以评估障碍和促进者以实施 在卫生部门和机构级别上，以告知未来的适应和传播 实施策略。 7.2。项目摘要/摘要 - 协作项目 医疗保健提供中最持久的挑战之一是质量。通常很容易确定哪个或 给定的代理商或计划向客户提供了多少服务，但是很难很难 确定这些服务的交付程度，或服务交付的哪些方面最大 对结果的影响。该协作项目基于科学前提，即可以定义质量， 通过对卫生部门合同惯例进行重新定义的测量和支持 实施科学方法可以评估这种创新战略，并确定其优势和 更广泛传播的弱点。在这个协作项目中，我们解决了一个持久的问题 质量通过：a）定义艾滋病毒预防服务质量的实施策略和 操作逻辑模型，高质量的服务将解决已知障碍和不平等 在社区，系统和客户层； b）数据收集以及质量改进和管理 （QIM）专注于质量和质量指标作为艾滋病毒预防中基于激励的可交付成果的策略 合同； c）与机构合作以确定质量挑战的培训和技术支持系统 服务提供并支持他们确定并制定解决这些挑战的方法；和d）a 协作研究设计，衡量每个组成部分的计划，采用和维持 实施策略，并应用程序化逻辑模型来检查每个组件对 假设的确定词，机制和结果。纽约市卫生部（NYC HD） 已经选择了基于质量的融资（QBF）模型来资助其艾滋病毒预防合同（与 传统费用为服务模型）作为减少访问，利用率不平等的实施策略 和预防艾滋病毒的结果，并同样减少纽约市最高的艾滋病毒事件 优先人群。这个协作项目有四个主要目标：（1）进行中断的时间 （ITS）分析以评估实施QBF模型的影响； （2）定性探索因素 这可能解释了在不同机构成功实施QBF方面的差异； （3）识别 使用纵向倍数与QBF模型的差异有效性显着相关的因素 回归分析； （4）测量模型的保真度和监视QBF在健康水平上的实施 部门和资助的机构。