A Mixed Methods Assessment of Clinic Characteristics Associated with Successful Scale-up & Sustainment of Systems Navigation & Psychosocial Counseling for People Who Inject Drugs with HIV in Vietnam

与成功扩大规模相关的临床特征的混合方法评估

• 批准号: 10700589
• 负责人: Sophia M Bartels
• 金额: $ 3.99万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2025-08-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700589
• 关键词: Affect; Caring; Characteristics; Climate; Clinic; Counseling; Data; Epidemic; Evidence based intervention; Excision; Fellowship; Foundations; Funding; Future; Goals; Government; HIV; Health; Human immunodeficiency virus test; Incidence; Individual; Injecting drug user; Intervention; Interview; Knowledge; Leadership; Linear Models; Maps; Measurement; Mentorship; Methods; Modification; National Institute of Drug Abuse; Outcome; Parents; Participant; Personal Satisfaction; Persons; Pharmaceutical Preparations; Population; Process; Provider; Province; Public Health; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Resources; Sample Size; Scientist; Site; Statistical Data Interpretation; Statistical Models; Surveys; System; Testing; Time; Vietnam; Vietnamese; Viral; Work; antiretroviral therapy; arm; barrier to care; career; cost; design; evidence base; experience; follow-up; implementation barriers; implementation facilitators; implementation intervention; implementation science; implementation strategy; implementation study; implementation trial; improved; indexing; low and middle-income countries; medication-assisted treatment; mortality; novel; organizational readiness; psychosocial; research to practice; scale up; skills; success; theories

ABSTRACT Globally and in Vietnam, people who inject drugs (PWID) are disproportionately impacted by the HIV epidemic. PWID have considerably lower levels of care engagement and experience worse HIV outcomes than individuals with HIV who do not inject drugs. Efforts to scale-up HIV testing and treatment have largely failed to reach PWID, who experience unique barriers to care. Even fewer of these evidence-based interventions (EBIs) have been normalized (the process by which an intervention is integrated into routine clinic care) and sustained, resulting in significant losses of time and resources. The success of EBI implementation and sustainment is affected by clinic characteristics, which can act as important implementation barriers or facilitators. However, the ways in which clinic characteristics are related to EBI fit, normalization, and sustainment are poorly understood. The proposed fellowship builds on the applicant’s prior background to prepare her for a career as an independent mixed methods researcher and implementation scientist. The specific fellowship goals are for the applicant to 1) develop a strong foundation in conducting HIV-related implementation science research; 2) build advanced quantitative analysis skills in analyzing and interpreting statistical models; 3) expand her expertise in conducting mixed methods research and analysis; and 4) deepen her skills in presenting research findings and grantsmanship. These goals will be accomplished through coursework, mentorship from the sponsor and mentorship team, and execution of the proposed research project. The proposed mixed methods research will be completed within the context of a larger NIDA-funded cluster randomized implementation trial with 42 HIV testing sites in 10 provinces in Vietnam (Scaling up HPTN 074: a Cluster Randomized Implementation Trial of an EBI for Antiretroviral Therapy for PWID in Vietnam, 5R01DA047876-02). This study will identify key clinic characteristics for scale-up and sustainment of the systems navigation and psychosocial counseling (SNaP) EBI in Vietnam, and examine how adaptations to both the intervention and implementation strategies influence sustainment of SNaP. Aim 1 will use qualitative interviews conducted with participant PWID (n=36) and clinic staff (n=24-36), survey data collected at baseline and endline, and the modified Delphi method (to improve scale-up measurement) with US and Vietnamese experts in HIV and implementation science to identify factors influencing clinic scale-up success of SNaP. Aim 2 will use clinic staff surveys across the 42 sites to evaluate sustainment of SNaP and clinic-level factors associated with sustainment. Aim 3 will involve 24-36 qualitative interviews with clinic staff and directors to determine how intervention and implementation strategy adaptations and clinic characteristics influence SNaP normalization and sustainment. The proposed research aligns with NIDA’s goals of bridging the research-to- practice gap by providing evidence-informed guidance to Ministries of Health in Vietnam for optimizing scale- up and sustainment of SNaP, which has the potential to increase wellbeing for PWID with HIV globally.

抽象的 在全球和越南，注射吸毒者 (PWID) 受到艾滋病毒流行的影响尤为严重。 与注射吸毒者相比，注射吸毒者的护理参与度要低得多，艾滋病毒感染结果也更差 扩大艾滋病毒检测和治疗范围的努力基本上未能成功。 注射吸毒者在护理方面遇到的独特障碍甚至更少。 已正常化（将干预措施纳入常规临床护理的过程）并且 持续，导致 EBI 实施的成功和资源的大量损失。 维持受到诊所特征的影响，这可能成为重要的实施障碍或 然而，临床特征与 EBI 拟合、标准化和相关性的方式。 拟议的奖学金建立在申请人之前的背景之上。 为她作为独立混合方法研究员和科学家实施的职业生涯做好准备。 具体的奖学金目标是让申请人 1) 为开展艾滋病毒相关研究奠定坚实的基础 实施科学研究；2）建立先进的分析和解释定量分析技能 统计模型；3) 扩展她进行混合方法研究和分析的专业知识；4) 深化； 她展示研究成果和资助的技能将通过以下方式实现。 课程作业、赞助商和指导团队的指导以及拟议研究的执行 拟议的混合方法研究将在 NIDA 资助的更大范围内完成。 在越南 10 个省份的 42 个 HIV 检测点进行的整群随机实施试验（扩大 HPTN 074：越南注射吸毒者抗逆转录病毒治疗 EBI 的整群随机实施试验， 5R01DA047876-02）本研究将确定扩大和维持的关键临床特征。 越南的系统导航和心理社会咨询 (SNaP) EBI，并研究如何适应 干预措施和战略都会影响 SNaP 目标 1 的维持实施。 对参与者注射吸毒者 (n=36) 和诊所工作人员 (n=24-36) 进行访谈，在基线收集调查数据 和终点，以及与美国和越南的改进德尔菲法（以改进放大测量） HIV 和科学专家确定影响 SNaP Aim 临床规模成功的因素。 2 将利用 42 个地点的诊所工作人员调查来评估 SNaP 和诊所层面因素的维持情况 目标 3 将涉及与诊所工作人员和主管进行 24-36 次定性访谈，以 确定干预和策略调整以及临床实施特征如何影响 SNaP 拟议的研究符合 NIDA 的目标，即在研究与研究之间架起桥梁。 通过向越南卫生部提供以证据为依据的指导来优化规模，从而缩小实践差距 SNaP 的建立和维持，有可能提高全球感染艾滋病毒的吸毒者的福祉。