Assessing Perceptions and Preferences around Long-acting Injectables (APPLI) in the Ryan White HIV/AIDS Program

评估 Ryan White HIV/AIDS 项目中对长效注射剂 (APPLI) 的看法和偏好

• 批准号: 10598553
• 负责人: Mary Kathryn Irvine
• 金额: $ 10.11万
• 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: 2021-04-16 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10598553
• 关键词: Acceleration; Achievement; Address; Adherence; Administrator; Appointment; Area; Belief; Black race; Caring; Case Management; Case Manager; Cities; Client satisfaction; Clinical; Complex; Continuity of Patient Care; County; Data; Disparity; Dose; Effectiveness; Ensure; Epidemic; Equity; Ethnic Origin; Evidence based intervention; Focus Groups; Funding; Goals; Government; HIV; HIV disparities; HIV therapy; HIV/AIDS; Health; Health Personnel; Health education; Heterogeneity; Home visitation; Injectable; Injections; International; Intervention; Interview; Joints; Latino; Low income; Maintenance; Marketing; Measures; Medical; New York; New York City; Oral; Outcome; Outcome Measure; Patients; Peer Review; Perception; Persons; Phase III Clinical Trials; Play; Population; Prevention; Primary Care; Protocols documentation; Provider; Public Health; Publications; Race; Randomized, Controlled Trials; Reduce health disparities; Regimen; Reporting; Risk; Role; Rural; Safety; Sampling; Scientific Advances and Accomplishments; Self Management; Service delivery model; Services; Specific qualifier value; Surveys; System; Translating; United States Health Resources and Services Administration; United States National Institutes of Health; Universities; Viral; Viral Load result; Vulnerable Populations; Work; antiretroviral therapy; care coordination; dashboard; demographics; design; effectiveness/implementation hybrid; evidence base; expectation; experience; experimental study; field study; follow-up; health equity; implementation outcomes; implementation research; implementation science; implementation strategy; improved; innovation; insight; medical appointment; new technology; next generation; operation; panacea; patient oriented; patient population; pilot test; population health; preference; programs; scale up; service delivery; service providers; service utilization; suburb; symposium; therapy adherence; therapy design; therapy outcome; tool; transmission process; uptake; web site

Abstract The Ryan White HIV/AIDS Program is an essential platform for reducing health disparities among people with HIV (PWH) and scaling up evidence-based strategies to strengthen the HIV care continuum. We propose an implementation-science study based in New York Ryan White Part A (RWPA) programs, to inform the delivery of long-acting injectable (LAI) antiretroviral therapy (ART) and related supportive services to low- income, largely Black and Latino/a PWH who have struggled with daily oral ART adherence. As a major biomedical advance de-necessitating adherence to daily dosing, LAI ART could greatly increase opportunities for health, survival and transmission prevention, particularly in populations confronting complex barriers to viral load suppression. However, optimizing the public health impact of LAI ART will require implementation science to assess perceptions and preferences around LAI versus daily oral regimens, identify support services and delivery mechanisms suited to promoting LAI uptake and engagement, and address the role of provider beliefs as to which patients should be offered LAI options. In the absence of this groundwork, LAI ART may primarily reach those who are already relatively advantaged, and even exacerbate HIV disparities. The proposed project aims to: (1) Elicit perceptions, barriers/facilitators and expectations of LAI versus daily oral ART delivery options, in six focus groups of RWPA medical case management (MCM) patients, core staff and prescribing providers; (2) Quantify preferences and drivers of engagement in ART delivery and support strategies, including options for LAI and daily oral ART, via discrete choice experiments (DCEs) with 200 patients and 200 providers; and (3) Select and pilot strategies to promote LAI ART uptake, adherence and impact in real-world care settings. Timely formative work on patient and provider perceptions and preferences will be essential to a successful, equitable rollout of LAI ART. The proposed study will yield valuable insights into barriers and facilitators of LAI ART engagement in RWPA MCM programs designed for PWH with documented adherence barriers. Specifically, focus groups and DCEs will elucidate how (and which) RWPA-funded services (e.g., for patient assessment, joint care planning, health education, home visits, and accompaniment to appointments) may be applied or adapted to enhance LAI ART outcomes. Aim 3 pilot testing and a follow-up RCT will further inform LAI ART delivery strategy refinement and scale-up, by measuring both implementation and clinical outcomes of strategies emerging from the proposed project. Through a partnership between the Institute for Implementation Science and Population Health (ISPH) at the City University of New York, the New York City Health Department and six RWPA service provider agencies, products from the proposed project and follow-up RCT will be translated to local HIV services planning and practice improvements, while being disseminated nationally and internationally through peer-reviewed publications, presentations at scientific conferences and posting on New York’s ISPH-designed/maintained Ending-the-Epidemic Dashboard website.

抽象的 瑞安白人艾滋病毒/艾滋病计划是减少人们健康差异的重要平台 使用艾滋病毒（PWH）并扩大基于证据的策略来加强艾滋病毒护理连续体。我们建议 一项基于纽约Ryan White A Part A（RWPA）计划的实施科学研究，以告知 提供长效注射（LAI）抗逆转录病毒疗法（ART）和相关支持的服务 收入，主要是黑人和拉丁裔/PWH，他们在日常口头依从性方面苦苦挣扎。作为专业 生物医学提前依赖日常给药，LAI艺术可以大大增加机会 为了健康，生存和传播预防，特别是在遇到病毒复杂障碍的种群中 负载抑制。但是，优化LAI艺术的公共卫生影响将需要实施科学 要评估LAI与每日口服方案周围的看法和偏好，请确定支持服务和 用于促进LAI吸收和参与度的交付机制，并解决提供者信念的作用 至于应提供哪些患者的LAI选择。在没有这一基础工作的情况下，赖艺术可能主要 达到那些已经相对有利甚至加剧HIV差异的人。拟议的项目 目的是：（1）引起人们对LAI与每日口服艺术品的看法，障碍/促进者的期望 选项，在RWPA医疗案例管理（MCM）患者，核心人员和开处方的六个焦点小组中 提供者； （2）量化艺术交付和支持策略参与的偏好和驱动力， 包括LAI和每日口服艺术的选择，通过离散选择实验（DCE），有200名患者和200名患者 提供者； （3）选择和试点策略，以促进LAI艺术的吸收，遵守和影响现实世界的影响 护理设置。及时对患者和提供者的看法和偏好的形成性工作对于 成功的，公平的Lai艺术推出。拟议的研究将对障碍和 LAI艺术参与RWPA MCM计划的促进者，专为PWH设计，并有记录的依从性 障碍。特别是，焦点小组和DCE将阐明如何（以及哪个）RWPA资助的服务（例如 患者评估，联合护理计划，健康教育，家庭就诊和预约住宿） 可以应用或改编以增强LAI艺术成果。 AIM 3试点测试和后续RCT将进一步 通过衡量实施和临床来告知LAI艺术交付策略的完善和扩大规模 拟议项目中出现的策略结果。通过研究所之间的伙伴关系 纽约市城市大学的实施科学与人口健康（ISPH） 卫生部门和六个RWPA服务提供商机构，拟议项目的产品和后续行动 RCT将转化为当地的艾滋病毒服务计划和练习改进，同时被传播 通过同行评审的出版物，科学会议的演讲以及国际上的国际和国际 发布在纽约ISPH设计/维护的流动仪表板网站上。