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

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

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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，90-90-90个目标的成就不会因获得负担得起的护理和治疗而受到危害，但是，由于艾滋病毒病毒抑制（VS）的持续差异。复杂的行为和结构性障碍维护VS需要协调的组合方法，以满足医疗和社会服务需求。 2009年，28岁纽约市（NYC）卫生与精神卫生部的Ryan White A Part A Part A Part A Part A Part A Part A Part A Part （DOHMH）启动了针对最脆弱的，最脆弱的多组分HIV护理协调计划（CCP）纽约市患有艾滋病毒（PLWH）的高需求的人。一项系统的CCP有效性研究始于2013年（R01 MH101028; PIS：Irvine，Nash）。迄今为止的调查结果表明，CCP优于对高必要亚组的通常护理 plwh，但在短期和长期VS中仍然有很大的改善空间。直接证明练习反馈循环，DOHMH在2018年实施了精致的CCP模型。更大的专注，裁缝和预计关键组件的提示将增加CCP的参与度，覆盖率，忠诚度，可伸缩性，有效性和影响。拟议研究的目的是：1）估计修订后的CCP的有效性使用实验方法（AIM 1）及时vs（≤4个月）； 2）估计修订后的CCP的有效性（vs. 使用长期VS的护理，包括12个月的VS和24-36个月的耐用病毒抑制（DVS）严格的观察比较组方法（AIM 2）； 3）确定提供商和客户的属性和驱动程序参与干预措施，提供者和客户偏好，以进行未来修订的CCP交付和收据（AIM 3）。先前的研究尚未证明任何干预措施可有效改善短期和长期与之间的干预措施许多具有主要艾滋病毒护理障碍的PLWH继续参与。拟议的研究将在大型上进行在现实世界中的艾滋病毒服务设置中扩展，将记录证据信息实施的推出和影响干预模型的课程校正集中在这些最脆弱的PLWH上。这样，工作将推进第二代干预措施能够加强无法加强无法执行的护理连续性由于重大的结构或社会心理障碍，在现有干预措施中实现所需的艺术结果。