Implementation Science of a Data-to-Care Strategy to Improve HIV Continuum and Drug Treatment Outcomes for Out of Care PLWH in Ukraine

数据到护理策略的实施科学，以改善乌克兰非护理艾滋病毒感染者的艾滋病毒连续体和药物治疗结果

• 批准号: 10160215
• 负责人: Kostyantyn Dumchev
• 金额: $ 24.17万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10160215
• 关键词: AIDS/HIV problem; Address; Adherence; Adoption; Affect; Appointment; Area; Caring; Case Management; Characteristics; Client; Climate; Clinic; Clinical; Clinical Data; Clinical Management; Complement; Complex; Consolidated Framework for Implementation Research; Continuity of Patient Care; Cost Analysis; Data; Decision Making; Diagnosis; Drops; Drug Prescriptions; Eastern Europe; Effectiveness; Enrollment; Evaluation; Evidence based intervention; Evidence based practice; Goals; HIV; HIV Seropositivity; HIV diagnosis; Health; Individual; Infrastructure; Injecting drug user; Institutes; International; Intervention; Interview; Laboratories; Medical; Medical Surveillance; Mental Health; National Institute of Drug Abuse; Organizational Policy; Outcome; Participant; Patient Care; Patients; Pharmacotherapy; Policies; Positioning Attribute; Practice Management; Process; Provider; Psychosocial Assessment and Care; Psychosocial Factor; Public Health; Randomized; Randomized Clinical Trials; Research; Research Priority; Services; Site; Social Work; Structure; System; Test Result; Testing; Treatment outcome; USAID; Ukraine; United States; Viral; Vulnerable Populations; addiction; ancillary care; care outcomes; care providers; care systems; comorbidity; control trial; cost effectiveness; data integration; data management; effectiveness evaluation; experience; implementation science; implementation strategy; improved; interest; intravenous drug use; low and middle-income countries; medical information system; medication compliance; multiple data sources; organizational structure; primary outcome; programs; scale up; secondary outcome; service utilization; standard of care; substance abuse treatment; substance use; surveillance data

The goal of this project is to develop and pilot a data-to-care strategy to improve HIV care outcomes among not-in-care PLWH in Ukraine. Data-to-Care (D2C) is a high-impact public health strategy that integrates multiple sources of data such as clinical data from medical information systems, surveillance data, and ongoing case management assessments with clients to identify PLWH who are not in care, engage them in care, and manage the HIV Care Continuum. D2C strategies complement evidence-based practices for HIV care adherence by integrating clinical and case management data at multiple points along the HIV care continuum, using systematic assessments to identify unmet needs such as substance abuse treatment and make appropriate care referrals, and using data to inform practice changes and improve linkage to and retention in care. D2C strategies have been effectively implemented in jurisdictions throughout the United States but are not standard of care in low- and middle-income countries (LMICs) such as Ukraine. In Ukraine, of the approximately 244,000 estimated people living with HIV in Ukraine, only 44% are receiving ART. At least 50% of PLWH in Ukraine acquired HIV though intravenous drug use and are likely to be active people who inject drugs (PWID). ART use rates are particularly low among HIV-positive PWID, with only 38% on ART and 28% virally suppressed. This study’s Specific Aims are: (1) to adapt and develop a D2C implementation strategy for Ukraine; (2) to pilot a randomized clinical trial of a D2C strategy versus standard of care; and (3) to assess the feasibility, acceptability, and implementation-related processes and outcomes of the D2C strategy. We will use a cluster randomized control trial in PEPFAR-designated high priority regions in Ukraine (4 clinical settings and 160 total participants). Main outcomes of interest are: engagement/re-engagement in HIV care, MAT and other ancillary care service; ART initiation/re-initiation; and viral suppression. Outcomes will be assessed at 6 and 12- months post-baseline. Ukraine is well-positioned as a site to identify how D2C strategies can be implemented in LMICs. With the support of international stakeholders such as PEPFAR, the Ukrainian Ministry of Health is actively promoting the use of a medical information system (MIS) at the HIV clinic level. The MIS contains patient-level information on HIV care appointments kept, medication prescriptions, all diagnosed co- morbidities, and clinical and laboratory test results. This information can be mobilized in a D2C strategy that tracks patients through the care continuum, uses data to make decisions about patient care and improve case management practices, attends to psychosocial factors that affect medication adherence (e.g., mental health, addiction), and coordinates the provision of non-clinical social services. This project seeks to develop and test an intervention that influence organizational structure, climate, and culture to promote dissemination and adoption of evidence-based practices; and evaluate the adaptation process, and subsequent effectiveness of evidence-based interventions when implemented in real-world settings.

该项目的目的是制定和试行一种数据到保健策略，以改善艾滋病毒的护理结果 乌克兰的无保健PLWH。数据到护理（D2C）是一种高影响的公共卫生策略，可集成 多个数据来源，例如医疗信息系统的临床数据，监视数据和持续的数据源 与客户进行案例管理评估，以识别不在照料的PLWH，让他们参与护理，并 管理艾滋病毒护理连续性。 D2C策略补充了基于证据的艾滋病毒护理实践 通过在艾滋病毒护理连续体沿多个点整合临床和病例管理数据来依从性， 使用系统评估来确定未满足的需求，例如滥用药物治疗并使 适当的护理转介，并使用数据为实践的更改提供信息，并将与之联系 关心。 D2C策略已在美国各地有效地实施，但 在乌克兰等低收入和中等收入国家（LMIC）中不是护理标准。在乌克兰 在乌克兰，大约有244,000名艾滋病毒感染者的人正在接受艺术。至少50％ 乌克兰的PLWH通过静脉吸毒而获得了艾滋病毒，很可能是活跃的人注射 药物（PWID）。在HIV阳性PWID中，艺术使用率尤其低，仅38％的ART和28％ 病毒抑制。该研究的具体目的是：（1）适应和制定D2C实施策略 乌克兰; （2）试行D2C策略与护理标准的随机临床试验； （3）评估 D2C策略的可行性，可接受性和与实施相关的过程和结果。我们将使用 乌克兰PEPFAR指定的高优先级地区的簇随机对照试验（4个临床环境和 160名参与者）。感兴趣的主要结果是：参与/重新参与HIV护理，MAT和其他 辅助护理服务；艺术倡议/重新定论；和病毒抑制。结果将在6点进行评估，并且 基线后12个月。乌克兰作为一个网站，以确定D2C策略如何 在LMIC中实施。在国际利益相关者（例如Pepfar）的支持下，乌克兰部 健康的人正在积极促进在艾滋病毒诊所层面上使用医疗信息系统（MIS）。错误 包含有关保留艾滋病毒护理预约，药物处方的患者级信息 病态以及临床和实验室测试结果。可以在D2C策略中动员此信息 通过护理连续体跟踪患者，使用数据来决定患者护理并改善病例 管理实践，照顾影响药物依从性的社会心理因素（例如，心理健康， 成瘾），并协调提供非临床社会服务的提供。该项目旨在开发和测试 影响组织结构，气候和文化的干预措施，以促进传播和 采用循证实践；并评估适应过程以及随后的有效性 基于证据的干预措施在现实世界中实施。