Structured Peer-delivered ART and Reentry Community Strategy (SPARCS) to overcome barriers to HIV care continuity during community reentry from incarceration in South Africa

结构化的同伴提供的 ART 和重返社区策略 (SPARCS)，以克服南非监狱出狱重返社区期间艾滋病毒护理连续性的障碍

• 批准号: 10700511
• 负责人: CHRISTOPHER J HOFFMANN
• 金额: $ 62.85万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700511
• 关键词: Address; Adjusted Life Years; Adopted; Adoption; Adult; Age; Behavioral; Caring; Cause of Death; Clinic; Collaborations; Communities; Continuity of Patient Care; Educational Curriculum; Effectiveness; Elements; Environment; Equilibrium; Failure; Future; General Population; Goals; Government; Group Structure; HIV; Health; Health system; Hybrids; Imprisonment; Individual; Intervention; Intervention Studies; Interview; Knowledge; Life; Maintenance; Manuals; Measures; Methods; Modification; National Institute of Mental Health; Outcome; Output; Participant; Persons; Pilot Projects; Policy Maker; Population; Prevalence; Problem Solving; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Resources; Role; Sampling; Schedule; Self Efficacy; Services; Social support; South Africa; South African; Structure; Techniques; Testing; Treatment Failure; United States National Institutes of Health; Viral Load result; Work; age group; antiretroviral therapy; community clinic; community reentry; comparative cost effectiveness; cost; cost comparison; cost effectiveness; design; disparity reduction; effectiveness evaluation; effectiveness outcome; effectiveness testing; effectiveness/implementation study; epidemic response; financial literacy; high risk; implementation cost; implementation determinants; implementation fidelity; implementation strategy; improved; improved outcome; interest; member; peer; pilot test; primary outcome; scale up; sex; skills; societal costs; statistics; substance use; treatment arm; treatment as usual; trial design; trial enrollment; usual care arm

PROJECT SUMMARY HIV remains the leading cause of death among adults in South Africa despite the availability of antiretroviral therapy (ART) due to failure to initiate ART and failure to remain on ART. Gaps in HIV care are especially prominent among key populations at high risk for both HIV and reduced use of HIV services. One population with an HIV prevalence double the age and sex-matched general population (23%) and with low engagement in HIV care is individuals recently released from incarceration. During incarceration >90% initiate ART; following reentry into the community only 34% remain in care. The transition from the controlled carceral environment and its restricted autonomy to life in the community requires reestablishing planning skills, self- efficacy, and social support and overcoming bureaucratic barriers to accessing community clinics. We have demonstrated that an intervention that circumvents clinic barriers by directly providing ART and builds behavioral skills through peer-facilitator led group sessions improves care continuity following release from incarceration. In a pilot study of this intervention supported by NIMH, termed SPARCS, among 176 participants, 36% of those in the care as usual compared to 61% of those in the intervention arm were in-care 6 months after corrections release. These results raise important questions regarding possibility of programmatic scale-up. Scale-up requires achieving a balance between effectiveness, feasibility, and cost. Notably, the tension between effectiveness and feasibility may require reducing overall effectiveness – such as by eliminating a component of SPARCS – to increase feasibility. To explore each of these questions, we are proposing a hybrid type I effectiveness-implementation study structed with the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). First, we are proposing a 2x2 factorial design to maximize power of a randomized controlled trial of the Full-SPARCS intervention and the two distinct components termed “ART-SPARCS” and “Group-SPARCS” and usual care, to test for a difference in viral load suppression 6 months from correctional facility release. Second, we propose characterize implementation in terms of reach, adoption or adoption potential, acceptability, and fidelity. Finally, will use findings from the RCT to inform costing and cost-effectiveness to inform policy makers regarding cost of SPARCS and components and cost-effectiveness of each component and the full SPARCS to inform implementation cost and potential long-term sustainability or maintenance. This project has the potential to generate considerable new knowledge on interventions that can improve care continuity for this population and key findings for potential scale-up relevant to policy makers. This proposed study has the potential to generate actionable knowledge to improve outcomes for community reentrants and contribute to overall goals of HIV epidemic control.

项目摘要 尽管有抗逆转录病毒，但艾滋病毒仍然是南非成年人死亡的主要原因 治疗（ART）由于未能发起艺术和未能继续艺术而引起的治疗。尤其是艾滋病毒护理中的差距 在艾滋病毒和减少艾滋病毒服务使用的高风险的主要人群中，重要人群中的突出人群。一个人口 艾滋病毒的患病率是年龄和性别匹配的一般人群的两倍（23％），参与度较低 艾滋病毒护理是最近从继承中释放的人。在继承期间> 90％的启动艺术； 在进入社区之后，只有34％的人仍在保养下。从受控式的过渡 环境及其对社区生活的限制自治需要重新建立计划技能，自我 功效，社会支持以及克服进入社区诊所的官僚障碍。我们有 证明了通过直接提供艺术并建造临床障碍来规避诊所障碍的干预措施 通过同伴 - 核能LED小组会议的行为技能可改善从发行后的护理连续性 在一项对NIMH支持的这项干预措施的试点研究中，称为Sparcs，在176 参与者，像往常一样接受护理的人中有36％，而干预部门中有61％ 校正后6个月发布。这些结果提出了有关可能的重要问题 编程缩放。扩大需要在有效性，可行性和成本之间达到平衡。 值得注意的是，有效性和可行性之间的张力可能需要降低总体效率 - 例如 通过消除SPARC的组成部分，以提高可行性。为了探索每个问题，我们是 提出一项由Re-Aim框架构造的I型I型有效性研究研究（触及， 有效，采用，实施，维护）。首先，我们提出了2x2阶乘设计 最大化全SPARCS干预的随机对照试验的功率和两种不同 被称为“ Art-Sparcs”和“ Group-Sparcs”和通常的护理的组件，以测试病毒负荷的差异 抑制矫正设施释放6个月。其次，我们建议在 覆盖范围，采用或采用潜力，可接受性和忠诚度。最后，将使用RCT中的发现 告知成本效益，以告知政策制定者有关SPARC和组件的成本 每个组件和全部SPARC的成本效益，以告知实施成本和潜力 长期可持续性或维护。该项目有可能产生新的考虑 了解可以改善该人群的护理连续性的干预措施以及潜在的关键发现 与决策者相关的扩展。这项拟议的研究有可能产生可行的知识 改善社区重新进入的结果，并为艾滋病毒流行病控制的整体目标做出贡献。