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

基本信息

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
项目类别：
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

项目摘要

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·怀特艾滋病毒/艾滋病项目是减少人与人之间健康差距的重要平台我们建议加强艾滋病毒护理的连续性。一项基于纽约 Ryan White A 部分 (RWPA) 计划的实施科学研究，旨在为向低收入人群提供长效注射剂 (LAI) 抗逆转录病毒治疗 (ART) 和相关支持服务收入，主要是黑人和拉丁裔/艾滋病患者，他们在日常口服抗逆转录病毒治疗方面遇到困难。生物医学的进步不再需要坚持每日给药，LAI ART 可以大大增加机会为了健康、生存和预防传播，特别是在面临复杂病毒障碍的人群中然而，优化 LAI ART 对公共卫生的影响需要科学的实施。评估对 LAI 与每日口服疗法的看法和偏好，确定支持服务和适合促进 LAI 吸收和参与的交付机制，并解决提供者信念的作用在缺乏这一基础的情况下，应该向哪些患者提供 LAI 方案，LAI ART 可能主要是这样。覆盖那些已经相对有利的人，甚至加剧艾滋病毒差距。旨在：(1) 引出对 LAI 与每日口服 ART 治疗的看法、障碍/促进因素和期望 RWPA 医疗案例管理 (MCM) 患者、核心人员和处方的六个焦点小组的选项 (2) 量化参与 ART 交付和支持策略的偏好和驱动因素，通过对 200 名患者和 200 名患者进行离散选择实验 (DCE)，包括 LAI 和每日口服 ART 的选择 (3) 选择和试点战略，以促进 LAI ART 在现实世界中的采用、坚持和影响及时了解患者和提供者的看法和偏好对于形成护理环境至关重要。成功、公平地推出 LAI ART 拟议的研究将对障碍和问题产生有价值的见解。 LAI ART 参与 RWPA MCM 计划的促进者，该计划专为 PWH 设计，并有记录的遵守情况具体来说，焦点小组和 DCE 将阐明 RWPA 资助的服务如何（以及哪些）（例如，患者评估、联合护理计划、健康教育、家访和预约住宿）可以应用或调整以增强 LAI ART 的结果，后续 RCT 将进一步进行。通过衡量实施和临床，为 LAI ART 实施策略的完善和扩大提供信息通过研究所之间的合作伙伴关系得出拟议项目的战略成果。纽约市立大学实施科学与人口健康 (ISPH)，纽约市卫生部和六个 RWPA 服务提供机构、拟议项目的产品和后续行动 RCT 将转化为当地艾滋病毒服务规划和实践改进，同时进行传播通过同行评审的出版物、在科学会议上的演讲和在纽约 ISPH 设计/维护的 Ending-the-Epidemic Dashboard 网站上发布。