South Africa's new Central Chronic Medicine Dispensing and Distribution program: assessing the clinic, patient, and community impact

南非新的中央慢性药物配发和分配计划：评估诊所、患者和社区的影响

• 批准号: 10194606
• 负责人: Ingrid Valerie Bassett
• 金额: $ 68.29万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-26 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10194606
• 关键词: Adherence; Administrator; Adopted; Adoption; Africa South of the Sahara; African; Behavioral Sciences; Biometry; Caring; Characteristics; Chronic; Chronic Care; Church; Client; Clinic; Clinical; Cohort Studies; Communities; Congestive; Continuity of Patient Care; Country; Data; Drops; Effectiveness; Electronic Health Record; Enrollment; Epidemiology; Face; Goals; Government; HIV; HIV antiretroviral; Health; Health Expenditures; Health Personnel; Health care facility; Health system; Human immunodeficiency virus test; Improve Access; Individual; Interdisciplinary Study; Intervention; Life; Life Expectancy; Medicine; Methods; Modeling; Municipalities; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacy Schools; Play; Policies; Policy Maker; Population; Population Programs; Positioning Attribute; Practical, Robust Implementation and Sustainability Model; Prevalence; Privatization; Public Health; Public Sector; Qualitative Methods; Quality of Care; Recommendation; Research; Resources; Role; Service delivery model; Services; Site; South Africa; South African; System; Testing; Time; Travel; Uninsured; Wait Time; antenatal; antiretroviral therapy; base; clinical practice; cohort; community based service; cost; density; design; expectation; flexibility; follow-up; home based service; implementation science; improved; innovation; interest; prevent; programs; prospective; randomized trial; scale up; service delivery; service providers; transmission process; uptake; virology

Project Summary Achieving the UNAIDS 90-90-90 target by 2020 in sub-Saharan Africa will require innovative solutions to meet the increasing demands placed on public health care facilities. With ART coverage in sub-Saharan Africa hovering around 50%, health systems face the dual challenge of increasing HIV testing and ART enrollment for those not yet in care and continuing to provide treatment to the millions of people already on ART. Community- based ART delivery is a potential strategy for maintaining long-term virologic suppression and retention in HIV care. South Africa’s new Central Chronic Medicine Dispensing and Distribution (CCMDD) program allows clinically stable patients to choose from a list of community pick-up points (e.g., private pharmacies, schools, churches) to access ART and therefore has the potential to offer more convenient services to patients and to decompress health facilities. The current proposal leverages this national policy change to assess the impact of this large scale service delivery intervention at the patient-, clinic-, and community-level over time in the high-density settlement of Umlazi in Durban, South Africa. Using a mixed-methods approach that incorporates the Practical, Robust Implementation and Sustainability Model (PRISM), we will comprehensively evaluate the impact of CCMDD at all 10 public sector clinics in Umlazi through the following specific aims: 1) To prospectively assess patient uptake of CCMDD and patient factors associated with favorable early clinical outcomes for CCMDD enrollees and to compare outcomes with non-enrollees; 2) To evaluate facilitators of and barriers to adoption of CCMDD by patients, clinic staff, and administrators using qualitative methods, and 3) To evaluate virologic suppression over time across all 10 public sector clinics in Umlazi using programmatic electronic health record data. This proposal is motivated by PA-17-182 to better understand system-level interventions using implementation science, which may increase the number of people consistently engaged in HIV care. We have played a major role for over a decade implementing and evaluating interventions along the HIV care continuum in South Africa and are well-positioned to evaluate the impact of this important policy change. Our results will inform clinical leaders and policymakers in high HIV prevalence settings developing community ART delivery systems that will enable life-long therapy for millions of people living with HIV. This research has the potential to change clinical practice throughout sub-Saharan Africa, where innovative and efficient approaches to long-term community-based HIV treatment delivery are urgently needed.

项目概要 到 2020 年，撒哈拉以南非洲地区要实现联合国艾滋病规划署 90-90-90 的目标，需要创新的解决方案来满足 对公共医疗保健设施的要求不断增加。撒哈拉以南非洲地区的 ART 覆盖范围 徘徊在 50% 左右，卫生系统面临着增加 HIV 检测和 ART 入学率的双重挑战 那些尚未接受治疗的人正在继续为数百万已经接受抗逆转录病毒治疗的人提供治疗。社区- 基于 ART 的治疗是维持 HIV 长期病毒学抑制和保留的潜在策略 关心。南非新的中央慢性药物配发和分销 (CCMDD) 计划允许 临床稳定的患者可以从社区接诊点列表中进行选择（例如私人药房、学校、 教堂）获得 ART，因此有可能为患者提供更方便的服务 为卫生设施减压。当前提案利用这一国家政策变化来评估其影响 随着时间的推移，这种在患者、诊所和社区层面的大规模服务提供干预 南非德班乌姆拉齐的高密度定居点。使用混合方法，其中包含 实用、稳健的实施和可持续性模型（PRISM），我们将全面评估 CCMDD 通过以下具体目标对 Umlazi 所有 10 家公共部门诊所产生影响： 1) 前瞻性评估患者对 CCMDD 的吸收以及与早期有利相关的患者因素 CCMDD 参与者的临床结果以及与非参与者的结果比较； 2）评估 使用定性方法来确定患者、诊所工作人员和管理人员采用 CCMDD 的促进因素和障碍 方法，以及 3) 使用以下方法评估 Umlazi 所有 10 个公共部门诊所随时间的病毒学抑制情况： 程序化电子健康记录数据。 该提案由 PA-17-182 推动，旨在通过实施更好地理解系统级干预措施 科学，这可能会增加持续从事艾滋病毒护理的人数。我们打过一场大满贯 十多年来在南非艾滋病毒护理连续过程中实施和评估干预措施方面发挥的作用 并有能力评估这一重要政策变化的影响。我们的结果将为临床提供信息 艾滋病毒高流行地区的领导者和政策制定者正在开发社区抗逆转录病毒疗法提供系统， 将为数百万艾滋病毒感染者提供终身治疗。这项研究有可能改变 整个撒哈拉以南非洲的临床实践，其中创新和有效的方法可实现长期 迫切需要以社区为基础的艾滋病毒治疗。