Adapting Peer Navigation for Out-of-Care Older Persons with HIV in Ukraine

为乌克兰失去护理的艾滋病毒老年人调整同伴导航

基本信息

批准号：
10258605
负责人：
Julia Rozanova
金额：
$ 23.08万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-15 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10258605
关键词：
Age Alcohols Asians COVID-19 Caring Central Asia Client Cluster randomized trial Collaborations Communities Counseling Data Diagnosis Drops Eastern Europe Elderly Ensure European Funding Future General Population Goals Guidelines HIV HIV diagnosis Health Health Benefit Hybrids Incidence Individual International Intervention Interview Link Measures Mental Depression Modeling Newly Diagnosed Opioid Outcome Participant Persons Pilot Projects Population Intervention Prevention Process Public Health Randomized Resources Running Standardization Substance Use Disorder Surveys Target Populations Telephone Testing Time Training Trust Ukraine Woman Zygote Intrafallopian Transfer acceptability and feasibility antiretroviral therapy barrier to care care outcomes comorbidity coronavirus disease cost evidence base experience improved innovation low and middle-income countries men mortality navigator intervention novel peer preservation shared decision making social stigma success treatment as usual treatment group treatment strategy uptake working group

项目摘要

Among the 5.5 million older people with HIV (OPWH) over 50 years, 80% live in low and middle income countries (LMIC). Ukraine, an emblematic LMIC in Eastern Europe and Central Asia (EECA), is the only world region with increasing HIV incidence and mortality. Among the 240,000 PWH in Ukraine, OPWH account for 25% of people with HIV but <30% are linked to ART within 6 months of diagnosis, with substantial proportions dropping out-of- care (OOC) once on ART. Consequently, mortality is 3-11 times higher than the age-matched general population. Key barriers to ART engagement for OPWH include substance use disorder, depression, and HIV stigma. PEPFAR has prioritized OPWH as an intervention target since only 43% of women and 34% of men were receiving ART in 2019. OPWH in particular have been impacted by COVID-19. In May 2020, our phone survey of 123 OPWH revealed that 58% needed assistance with their HIV care. To achieve the 95-95-95 HIV targets by 2030, Ukraine needs effective strategies to (re-)engage and retain OPWH in ART. In line with emerging differentiated care models, peer navigation (PN) is an evidence-based strategy to link and re-engage OOC PWH, including ART. Our qualitative data in Ukraine suggest OPWH prefer peers over professionals to engage them in HIV care. Peer-navigation, however, has not yet been adapted and tailored for OPWH in resource-limited settings though lessons learned from COVID may guide its delivery. Moreover, PN has repeatedly been superior to treatment as usual (TAU), but the extent to which peer/client dyads effectively interact has not yet been explored. We intend to tailor PN for OPWH using ADAPT-ITT, an evidence-based adaptation strategy, to create PROST (Peer-Run Optimal Strategy for Treatment or “To your health” in Ukrainian), and pilot test it to (re- )engage OPWH in care and ART. We hypothesize that the tailored PROST will more effectively (re-)engage OPWH and increase ART uptake by overcoming unique barriers to care relative to TAU. During the pilot RCT 10 trained Peers will deliver PROST for 12 weeks to 60 OOC OPWH compared to 30 OOC OPWH receiving TAU. Randomization will be stratified by previous ART experience and participants will be followed for 6 months. Outcomes will include measures of acceptability, feasibility, and preliminary efficacy. Using survey items from baseline, week 12, and week 24 on trust, compatibility, and perceived quality of peer-client interactions, we will conduct dyadic analyses of peers and clients to better understand shared decision-making and linkage to care outcomes. Innovation is high due to creating a differentiated care model to more effectively engage OPWH using a tailored strategy as well as the contribution of the novel dyadic analysis. Public health benefit is high due to the emerging need to intervene with OPWH, especially in the only major region where HIV incidence and mortality is increasing. To ensure compatibility with the community, findings will be shared with stakeholders including a Community Working Group (peers, clinicians), funders (PEPFAR, Global Fund), and implementers (MoH, NGOs) to guide a future Type I Hybrid, cluster randomized trial in Ukraine.

在 50 岁以上的 550 万艾滋病毒老年人 (OPWH) 中，80% 生活在低收入和中等收入国家 (LMIC) 乌克兰是东欧和中亚 (EECA) 的标志性中低收入国家，是世界上唯一一个拥有乌克兰 240,000 名艾滋病感染者中，OPWH 占 25%。患有 HIV，但诊断后 6 个月内与 ART 相关的 <30%，其中相当大比例的人退出了接受 ART 治疗后，死亡率比同龄普通人群高 3-11 倍。 OPWH 参与 ART 的主要障碍包括药物滥用障碍、抑郁症和艾滋病毒耻辱。 PEPFAR 将 OPWH 作为干预目标优先，因为只有 43% 的女性和 34% 的男性接受了 2019 年接受 ART。OPWH 尤其受到了 COVID-19 的影响。2020 年 5 月，我们进行了电话调查。 123 名 OPWH 透露，58% 的人需要艾滋病毒护理方面的援助，以实现 95-95-95 的艾滋病毒目标。到 2030 年，乌克兰需要有效的战略来（重新）吸引和保留 OPWH 参与 ART，以适应新兴市场的需求。差异化护理模式，同伴导航（PN）是一种基于证据的策略，用于联系和重新参与 OOC PWH，包括 ART 在内的乌克兰定性数据表明，OPWH 更喜欢同行而不是专业人士来吸引他们。然而，在艾滋病毒护理方面，同伴导航尚未针对资源有限的 OPWH 进行调整和定制。尽管从新冠疫情中汲取的经验教训可能会指导其实施，但 PN 一再表现出色。到照常对待（TAU），但同伴/客户二人组有效互动的程度尚未确定我们打算使用 ADAPT-ITT（一种基于证据的适应策略）为 OPWH 定制 PN，以创建。 PROST（同行运行的最佳治疗策略或乌克兰的“为了您的健康”），并对其进行试点测试（重新）让 OPWH 参与护理和 ART。我们认为定制的 PROST 将更有效地（重新）参与。 OPWH 并通过克服与 TAU 相关的独特护理障碍来提高 ART 的采用率。 10 名受过培训的同行将向 60 名 OOC OPWH 提供为期 12 周的 PROST，而接受培训的有 30 名 OOC OPWH TAU 将根据之前的 ART 经验进行随机分组，并对参与者进行为期 6 个月的随访。结果将包括使用调查项目的可接受性、可行性和初步效果。基线、第 12 周和第 24 周，关于信任、兼容性和对等客户交互的感知质量，我们将对同行和客户进行二元分析，以更好地了解共同决策和与护理的联系由于创建了差异化护理模式以更有效地使用 OPWH，因此创新成果很高。量身定制的策略以及新颖的二元分析对公共卫生的贡献很高。迫切需要对 OPWH 进行干预，特别是在唯一一个艾滋病毒发病率和死亡率正在增加，为了确保与社区的兼容性，调查结果将与利益相关者分享。包括社区工作组（同行、圣人）、资助者（PEPFAR、全球基金）和实施者（卫生部、非政府组织）指导乌克兰未来的 I 型混合整群随机试验。