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 在全球范围内和越南，注射药物（PWID）的人受HIV流行的影响不成比例。 PWID的护理参与程度较低，并且经历了比 不注射毒品的艾滋病毒的人。扩大艾滋病毒测试和治疗的努力在很大程度上未能 到达PWID，他经历了独特的护理障碍。这些基于证据的干预措施（EBIS）甚至更少 已经将干预措施整合到常规诊所护理中的过程中已归一化）和 持续，导致时间和资源的巨大损失。 EBI实施的成功和 维持受到诊所特征的影响，可以作为重要的实施障碍或 促进者。但是，诊所特征与EBI拟合，标准化和 维持知之甚少。拟议的奖学金是在申请人先前的背景下建立的 为她的职业做好准备，成为独立的混合方法研究人员和实施科学家。 特定的奖学金目标是申请人的1）在与HIV有关 实施科学研究； 2）在分析和解释中建立高级定量分析技能 统计模型； 3）扩大她在进行混合方法研究和分析方面的专业知识； 4）加深 她在介绍研究结果和授予技巧方面的技能。这些目标将通过 课程工作，赞助商和精明的团队的精神职位以及拟议研究的执行 项目。提出的混合方法研究将在较大的NIDA资助的背景下完成 在越南10个计划中，有42个HIV测试站点的聚类随机实施试验（扩大HPTN） 074：EBI抗逆转录病毒治疗的群集随机实施试验，越南PWID 5R01DA047876-02）。这项研究将确定关键的诊所特征，以扩大和维持 系统导航和社会心理咨询（SNAP）EBI在越南，并研究如何适应 干预和实施策略都会影响SNAP的维持。 AIM 1将使用定性 与参与者PWID（n = 36）和诊所工作人员（n = 24-36）进行的访谈，基线收集的调查数据 和端线，以及经过改进的Delphi方法（以改善我们和越南人的规模测量） 艾滋病毒和实施科学专家，以识别影响临床扩大成功的因素。目的 2将使用42个站点的诊所工作人员调查来评估快照和诊所级别的维持 与维持相关。 AIM 3将涉及24-36次与诊所工作人员和董事的定性访谈 确定干预和实施策略适应和诊所特征如何影响SNAP 正常化和维持。拟议的研究符合NIDA桥接研究的目标 通过向越南卫生部提供证据的指导来实践差距，以优化规模 SNAP的UP和维持，这有可能增加与全球艾滋病毒的PWID的福祉。