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

• 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
• 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

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年以来，在550万艾滋病毒（OPWH）的老年人中，有80％的人生活在低收入国家和中等收入国家 （LMIC）。乌克兰是东欧和中亚（EECA）的象征性LMIC，是唯一一个拥有的世界地区 增加艾滋病毒的发病率和死亡率。在乌克兰的240,000 PWH中，OPWH占25％的人 艾滋病毒均在诊断后的6个月内与艾滋病毒相关，但<30％与艺术有关，大量比例下降了 护理（OOC）一次艺术。因此，死亡率比年龄匹配的一般人群高3-11倍。 OPWH的艺术参与的关键障碍包括药物使用障碍，抑郁症和HIV污名。 PEPFAR将OPWH优先为干预目标，因为只有43％的女性和34％的男性是 2019年接受艺术。尤其是OPWH受到Covid-19的影响。 2020年5月，我们的电话调查 在123个OPWH中，有58％的人需要在其艾滋病毒护理方面提供帮助。达到95-95-95 HIV目标 到2030年，乌克兰需要有效的策略才能（重新）参与和保留ART WH。与新兴 差异化护理模型，同行导航（PN）是一种基于证据的策略，用于连接和重新接触OOC PWH， 包括艺术。我们在乌克兰的定性数据表明，OPWH更喜欢同行，而不是专业人士来吸引他们 在艾滋病毒护理中。然而，在资源限制中，尚未针对OPWH对同行循环进行调整和量身定制 尽管从Covid中学到的经验教训可以指导其交付。此外，PN反复是优越的 像往常 探索。我们打算使用基于证据的适应策略Adapt-Itt量身定制PN，以创建 Prost（乌克兰人的同伴运行的最佳治疗策略或“对您的健康”），并试点对其进行测试（重新 ）让OPWH参与护理和艺术。我们假设量身定制的专业将更有效地（RE-）参与 OPWH并通过克服相对于Tau的独特护理障碍来增加艺术吸收。在飞行员RCT期间 10个训练有素的同伴将提供12周至60 OOC OPWH，而30个OOC OPWH接收 tau。随机分组将由以前的艺术经验进行分层，参与者将持续6个月。 结果将包括可接受性，可行性和初步效率的度量。使用来自 基线，第12周和第24周关于同伴 - 客户互动的信任，兼容性和感知质量，我们将 对同行和客户进行二元分析，以更好地了解共同的决策和联系以进行护理 结果。创新由于创建了差异化的护理模型，可以更有效地使用OPWH 量身定制的策略以及新型二元分析的贡献。由于公共卫生益处很高 新兴需要干预OPWH，尤其是在唯一艾滋病毒事件和 死亡率正在增加。为了确保与社区的兼容性，将与利益相关者分享发现 包括社区工作组（同行，临床医生），资金（PEPFAR，全球基金）和实施者 （MOH，非政府组织）指导乌克兰的未来I型混合动力，群集随机试验。