Systems analysis and improvement approach to improve integration of HIV prevention and treatment services

提高艾滋病毒预防和治疗服务一体化的系统分析和改进方法

基本信息

批准号：
10597692
负责人：
McKenna Claire Eastment
金额：
$ 71.42万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-04-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10597692
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Adopted Adoption Africa South of the Sahara African Age Area Budgets Caring Client Clinic Cluster randomized trial Consolidated Framework for Implementation Research Counseling County Data Dissemination and Implementation Effectiveness Family Planning Family health status Female Adolescents Guidelines HIV HIV Infections Health Health Personnel Health Policy Health care facility Healthcare Systems Home Hospitals Human Resources Human immunodeficiency virus test Incidence Intervention Kenya Logic Maintenance Maps Modeling NIH Office of AIDS Research Oral Outcome Persons Policies Politics Population Positioning Attribute Prevalence Prevention Primary Care Procedures Process Public Health Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reproductive Health Research Research Priority Services Sexual Health Southern Africa Surveys Systems Analysis Testing Time Universities Washington Woman Work aged budget impact compare effectiveness comparison control comparison intervention cost effectiveness evaluation evidence base experience falls implementation evaluation implementation facilitators implementation research implementation science implementation strategy improved incremental cost innovation men organizational readiness pre-exposure prophylaxis prevention service programs reproductive scale up screening seropositive therapy development tool treatment arm treatment as prevention treatment services uptake young woman

项目摘要

East and Southern Africa is home to 6.2% of the world’s population but includes 54% of all people living with HIV (PLWH). In this region, three out of five PLWH are women, and there is a particularly high burden of HIV amongst adolescent girls and young women (AGYW). Over half of African women use family planning (FP) services. Integration of HIV prevention and treatment with FP services holds promise for supporting progress toward the UNAIDS 95-95-95 targets for testing, treatment, and prevention. Nonetheless, integration of even basic HIV prevention and treatment services into FP clinics remains low and how best to integrate these services is still unknown. In a previous trial, the Systems Analysis and Improvement Approach (SAIA), was an effective implementation strategy for improving HIV counseling and testing in a small selection of FP clinics in Mombasa County, Kenya when delivered by research staff. SAIA incorporates a cascade analysis tool, sequential process flow mapping, and cycles of micro-intervention development, implementation, and assessment to improve a care cascade. More data is needed to understand if SAIA is effective for also improving linkage to HIV care and screening and linkage to pre-exposure prophylaxis (PrEP) in FP clinics when SAIA is delivered at scale by Kenyan public health workforce. The first objective of this study is to conduct a cluster-randomized trial evaluating the effectiveness of SAIA versus control (usual procedures with no specific intervention) for increasing HIV counseling, testing, linkage to HIV care, and screening and linkage to PrEP in new FP clients and new and returning AGYW clients. There will be a particular focus on the HIV prevention and treatment of AGYW in this study and any AGYW presenting for FP care will be prioritized. Quantitative and qualitative data will be analyzed using the RE-AIM framework to evaluate the program’s Reach, Effectiveness, Adoption, Implementation, and Maintenance. To understand how SAIA could be integrated into national Ministry of Health policies and programs, activity-based costing will be conducted to estimate the budget and program impacts of SAIA, scaled to a County level, from a Ministry of Health perspective. It is hypothesized that compared to control, SAIA will be effective at increasing HIV counseling, HIV testing, linkage to HIV care, and screening and linkage to PrEP for new FP clients and all new and returning AGYW FP clients when delivered at scale by Kenyan public health staff. The implementation evaluation, costing, and budget impact analysis will establish a road map for national-level implementation, positioning Kenya as a global leader in integrating FP/HIV services.

东非和南部非洲人口占世界人口的 6.2%，但其中 54% 的人口生活在艾滋病毒感染者（PLWH）在该地区，五分之三的感染者是女性，艾滋病毒感染负担特别高。超过一半的非洲妇女使用计划生育 (FP)。将艾滋病毒预防和治疗与计划生育服务相结合有望支持进展。实现联合国艾滋病规划署 95-95-95 检测、治疗和预防目标。计划生育诊所的基本艾滋病毒预防和治疗服务仍然很少，如何最好地整合这些服务在之前的试验中，系统分析和改进方法（SAIA）是一个未知的服务。改善艾滋病毒咨询和检测的有效实施策略，在少数 FP 诊所中进行肯尼亚蒙巴萨县由研究人员提供，其中包含级联分析工具，顺序流程映射以及微观干预开发、实施和实施的周期需要更多数据来了解 SAIA 是否也有效。改善 FP 诊所与 HIV 护理和筛查的联系以及与暴露前预防 (PrEP) 的联系当肯尼亚公共卫生人员大规模提供 SAIA 时，本研究的首要目标是：进行整群随机试验，评估 SAIA 与对照的有效性（通常程序无具体干预措施）以增加艾滋病毒咨询、检测、与艾滋病毒护理的联系以及筛查和联系新的 FP 客户以及新的和返回的 AGYW 客户中的 PrEP 将特别关注艾滋病毒。本研究中 AGYW 的预防和治疗以及任何接受 FP 护理的 AGYW 将被优先考虑。将使用 RE-AIM 框架分析定量和定性数据，以评估该计划的效果了解 SAIA 的影响范围、有效性、采用、实施和维护。将基于活动的成本核算纳入国家卫生部的政策和计划，估计卫生部 SAIA 的预算和计划影响（按县级划分）与对照相比，SAIA 将有效增加艾滋病毒咨询， HIV 检测、与 HIV 护理的联系以及针对新 FP 客户和所有新老客户的筛查和 PrEP 联系由肯尼亚公共卫生人员大规模交付后返回 AGYW FP 客户实施情况。评估、成本核算和预算影响分析将为国家级实施制定路线图，将肯尼亚定位为整合计划生育/艾滋病毒服务的全球领导者。