Strengthening the Safety Net: Testing a Novel Data-to-Suppression (D2S) Intervention Strategy in the Ryan White HIV/AIDS Program

加强安全网：在 Ryan White HIV/AIDS 项目中测试新型数据抑制 (D2S) 干预策略

• 批准号: 10615110
• 负责人: Mary Kathryn Irvine
• 金额: $ 59.38万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10615110
• 关键词: Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Anti-Retroviral Agents; Automobile Driving; Behavioral; Black Populations; Black race; COVID-19; COVID-19 pandemic; Caring; Characteristics; Cities; Client; Clinical; Communication; Communities; Continuity of Patient Care; County; Data; Data Collection; Data Linkages; Diagnosis; Enrollment; Epidemic; Evidence based intervention; Factor Analysis; Focus Groups; Funding; Future; Goals; Government; HIV; HIV Infections; HIV/AIDS; Health; Health Resources; Health system; Housing; Hybrids; Income; Intervention; Interview; Latinx; Latinx population; Learning; Left; Light; Link; Low Income Population; Low income; Maintenance; Measures; Medicaid; Medical; Methods; Modeling; Modification; Monitor; Neighborhoods; New York City; Outcome; Participant; Persons; Positioning Attribute; Poverty; Provider; Psychosocial Influences; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reduce health disparities; Reporting; Research; Resources; Route; Service setting; Services; Shapes; Site; Testing; Time; Translations; Triage; Uninsured; United States Health Resources and Services Administration; Viral; antiretroviral therapy; barrier to care; behavioral health; care coordination; data resource; data sharing; design; disparity reduction; effectiveness evaluation; epidemic preparedness; evidence base; experimental study; follow-up; health disparity; hybrid type 1 study; hybrid type 1 trial; implementation measures; implementation outcomes; implementation research; implementation science; improved; intervention delivery; intervention effect; meetings; multiple datasets; novel; outcome disparities; outreach; patient navigator; post-COVID-19; preference; programs; psychosocial; research to practice; response; safety net; scale up; service delivery; service programs; service providers; social; stem; success; surveillance data; telehealth; therapy adherence; treatment arm; trial design; uptake

Abstract The Ryan White HIV/AIDS Program (RWHAP) for low-income people with HIV (PWH) is a key resource for reducing HIV health disparities and scaling up evidence-based interventions. As RWHAP serves >50% of US PWH, RWHAP outcomes are vital to achieving “getting to zero”/ Ending the HIV Epidemic (EHE) Plan targets. As a grantee for RWHAP Part A (RWPA) funding distributed to the counties/cities severely affected by HIV, New York City (NYC) conducts regular HIV care continuum monitoring citywide and in its RWPA programs, which offer support services to reduce social and behavioral barriers to care/treatment. Local data consistently show lower viral suppression (VS) among RWPA clients in HIV care than among non-RWPA PWH in HIV care. Relative to NYC HIV cases overall, NYC RWPA clients (~14,000 per year) over-represent Black and Latinx PWH and high-poverty neighborhoods. To address local outcome disparities and to fill gaps left by data-to-care (D2C) strategies and research focused on medical care (re-)linkage, we propose to implement and rigorously evaluate the effectiveness of a novel ‘data-to-suppression’ (D2S) intervention among ~1,300 RWPA clients in HIV care but unsuppressed. Surveillance-based reports on unsuppressed clients plus D2S capacity-building assistance will guide RWPA providers in targeting and delivering evidence-informed strategies to improve VS. Our proposed aims are to: 1) Measure D2S intervention effects on timely VS and time to VS, in a stepped- wedge hybrid Type 1 trial; 2) Identify modifiable determinants of D2S response, by comparing characteristics of D2S-exposed clients who do and do not achieve VS, to recognize opportunities to tailor and strengthen the intervention; 3) Assess D2S acceptability and participant preferences and priorities for its implementation, in eight (client and provider) focus groups and in a discrete choice experiment (DCE) with RWPA staff (n=200). This proposal answers the call in PAR-20-036 for research to deepen understanding of the broader context of VS, by leveraging extensive/multiple datasets and resources and applying implementation science methods to test an intervention to improve service delivery and ultimately achieve VS. The study is also aligned with the National HIV/AIDS Strategy goal to reduce health disparities – in this case, a VS gap between RWPA clients in care and other PWH in care in the same jurisdiction. The proposed study’s hybrid, Type 1 trial design supports rapid dissemination and uptake beyond NYC, should the intervention prove effective. Through the D2S trial, analysis of factors driving D2S response, and primary data collection in NYC RWPA support- service settings, the project seeks to clarify future intervention directions for low-income, Black and Latinx PWH, whose care continuum advances are vital for meeting 90-90-90, “getting to zero” and EHE Plan goals. The project’s potential impact is heightened in the time of COVID-19, given disproportionate burden of COVID- 19 and related restrictions in the communities RWPA serves, and new obstacles to continuity of care/treatment and to maintaining close communication between medical and support-service providers about clients’ needs.

抽象的 Ryan White HIV/AIDS计划（RWHAP）针对艾滋病毒（PWH）的低收入人士（PWH）是一个关键资源 减少艾滋病毒健康差异并扩大基于证据的干预措施。因为RWAP服务于我们中的50％ PWH，RWHAP结果对于实现“达到零”/结束HIV流行（EHE）计划目标至关重要。 作为RWHAP A部分（RWPA）资金的受赠人 纽约市（纽约市）定期进行全市监测及其RWPA计划的监测， 提供支持服务以减少社会和行为障碍的护理/治疗。本地数据一致 在HIV护理中，RWPA客户中的病毒抑制（VS）低于HIV护理中的非RWPA PWH。 相对于NYC HIV案件总体而言，NYC RWPA客户（每年约14,000）过度代表黑色和拉丁裔 PWH和高贫困社区。解决本地结果分布并填补数据之间留下的空白 （D2C）以医疗保健（重新）联系的策略和研究，我们建议实施和严格 评估〜1,300个RWPA客户中新颖的“数据对抑制”（D2S）干预的有效性 艾滋病毒护理但不受限制。基于监视的未抑制客户的报告以及D2S的能力建设 援助将指导RWPA提供商针对和提供证据的策略以改善VS。 我们提出的目的是：1）在阶梯式 - 楔形杂种1型试验； 2）通过比较特征 D2S暴露的客户做也没有实现VS，以认识到量身定制和加强的机会 干涉; 3）评估D2S的可接受性和参与者的偏好和实施的优先级 八个（客户端和提供者）焦点小组以及与RWPA员工（n = 200）的离散选择实验（DCE）。 该提案回答了20-036年第20届PAR-036的呼吁，以加深对更广泛背景的理解 VS，通过利用广泛/多个数据集和资源并应用实施科学 测试干预措施以改善服务交付并最终实现VS的方法。该研究也是 与国家艾滋病毒/艾滋病战略的目标保持一致，以减少健康差异 - 在这种情况下， RWPA客户在同一管辖范围内从事护理和其他PWH。拟议的研究的混合动力，1型试验 如果干预措施有效，设计支持纽约市以外的快速传播和吸收。通过 D2S试验，驱动D2S响应的因素的分析以及NYC RWPA支持中的主要数据收集 - 服务设置，该项目旨在澄清低收入，黑色和拉丁裔的未来干预指示 PWH的继续前进对于达到90-90-90，“达到零”和计划目标至关重要。 鉴于COVID的伯宁（Covid）的不成比例，该项目的潜在影响会加剧。 RWPA社区的相关限制以及护理/治疗连续性的新障碍 并保持医疗和支持服务提供商之间有关客户需求的密切沟通。