PROMISE - Program Refinements to Optimize Model Impact and Scalability based on Evidence

PROMISE - 基于证据优化模型影响和可扩展性的程序改进

基本信息

批准号：
10083232
负责人：
Mary Kathryn Irvine
金额：
$ 57.98万
依托单位：
GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-02-15 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10083232
关键词：
Achievement Acquired Immunodeficiency Syndrome Behavioral Caring Centers for Disease Control and Prevention (U.S.)Cessation of life Cities Client Clinical Collaborations Complex Continuity of Patient Care Cues Data Data Sources Drops Drug usage Effectiveness Enrollment Epidemic Evidence based intervention Evolution Experimental Designs Feedback Funding Funding Agency Future Generations Goals Government HIV Health Health education Health system High Prevalence Incidence Infrastructure Institutes Intervention Investigation Latino Left Low income Medical Mental Health Methods Minority Modeling Morbidity - disease rate New York New York City Outcome Persons Policies Process Program Effectiveness Provider Public Health Randomized Research Research Support Resources Service delivery model Service setting Services Shapes Site Social Work Structure Subgroup Testing Time Training Translating Translations Universities Veterans Viral Viral Load result Work base care coordination care delivery comparison group course implementation design effectiveness study experience experimental study housing instability implementation science improved mortality multiple data sources population health preference prevent programs psychosocial scale up service providers social stigma transmission process treatment as usual

项目摘要

Abstract In New York, the achievement of 90-90-90 goals is jeopardized not by limited access to affordable care and treatment, but by persistent disparities in HIV viral suppression (VS). Complex behavioral and structural barriers to achieving and maintaining VS require coordinated, combination approaches to meet medical and social service needs. In 2009, at 28 Ryan White Part A (RWPA)-funded agencies, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) launched a multi-component HIV Care Coordination Program (CCP) directed toward the most vulnerable, high-need persons living with HIV (PLWH) in NYC. A systematic CCP effectiveness study began in 2013 (R01 MH101028; PIs: Irvine, Nash). Findings to date suggest that the CCP is superior to usual care for high-need subgroups of PLWH, but there remains substantial room for improvement in short- and long-term VS. In an immediate evidence-to- practice feedback loop, the DOHMH is implementing a refined CCP model in 2018. Greater focusing, tailoring and cues for delivery of key components are expected to increase CCP engagement, reach, fidelity, scalability, effectiveness and impact. The aims of the proposed study are to: 1) Estimate the effectiveness of the revised (vs. original) CCP on timely VS (≤4 months), using experimental methods (Aim 1); 2) Estimate the effectiveness of the revised CCP (vs. `usual care') on longer-term VS, including VS at 12 months and durable viral suppression (DVS) at 24-36 months, using rigorous observational comparison group methods (Aim 2); and 3) Identify attributes and drivers of provider and client engagement in the intervention and provider and client preferences for future revised-CCP delivery and receipt (Aim 3). Prior studies have not demonstrated any intervention to be effective at improving short- and long-term VS among the many PLWH with major barriers to HIV care continuum engagement. The proposed study, to be conducted on a large scale in real-world HIV service settings, will document the rollout and effects of evidence-informed implementation course corrections to an intervention model focused on these most vulnerable PLWH. In this way, the work will advance a second generation of interventions capable of strengthening the care continuum among PLWH who have been unable to achieve desired ART outcomes in existing interventions, due to major structural or psychosocial barriers.

抽象的在纽约，阻碍 90-90-90 目标实现的并非是获得负担得起的护理和治疗的机会有限，但艾滋病病毒抑制（VS）方面存在复杂的行为和结构障碍。维持 VS 需要协调一致的方法来满足医疗和社会服务需求 2009 年，28 岁。 Ryan White A 部分 (RWPA) 资助机构、纽约市 (NYC) 健康和心理卫生局 (DOHMH) 启动了一项针对最弱势群体的多组成部分艾滋病毒护理协调计划 (CCP)，纽约市高需求艾滋病毒感染者 (PLWH) 于 2013 年启动了一项系统的 CCP 有效性研究 (R01)。 MH101028；PI：Irvine、Nash）迄今为止的研究结果表明，对于高需求亚群体来说，CCP 优于常规护理。 PLWH，但在短期和长期 VS 方面仍有很大的改进空间。为了实践反馈循环，DOHMH 正在 2018 年实施改进的 CCP 模型。交付关键组件的线索预计将提高 CCP 的参与度、影响力、保真度、可扩展性和有效性拟议研究的目的是： 1) 评估修订后（与原始）CCP 的有效性。及时 VS（≤4 个月），使用实验方法（目标 1）；估计修订后的 CCP 的有效性（与“通常”相比）护理”）长期 VS，包括 12 个月的 VS 和 24-36 个月的持久病毒抑制 (DVS)，使用严格的观察比较组方法（目标 2）；以及 3）确定提供者和客户的属性和驱动因素参与干预以及供应商和客户对未来修订后的 CCP 交付和接收的偏好（目标 3）。先前的研究尚未证明任何干预措施可以有效改善短期和长期的 VS 许多艾滋病毒感染者在持续参与艾滋病毒护理方面存在重大障碍拟议的研究将进行大规模。现实世界艾滋病毒服务环境中的规模，将记录循证实施的推广和效果对针对这些最脆弱的感染者的干预模式进行修正，这项工作将推进第二代干预措施能够加强无法获得护理的艾滋病毒感染者的护理连续性由于重大的结构性或社会心理障碍，在现有干预措施中实现预期的 ART 效果。