Implementation Science to Strengthen the Integrated Care Continuum in Getting to Zero Contexts

项目摘要 在这个职业发展建议中，我的目标是使用实施科学策略来评估 在“实现零艾滋病”框架内提供综合护理连续体。德国技术合作署框架提议扩大， 扩大有效的艾滋病毒治疗和预防干预措施，如接触前预防措施， 治疗即预防（TasP），目标是消除新的艾滋病毒传播事件。德国技术合作署的举措包括： 最常见的是通过综合护理连续性实施。综合护理连续体描述了 对艾滋病毒阳性和阴性但易感染者的艾滋病毒护理和预防措施： 终止艾滋病毒的传播。许多司法管辖区已采取系统的努力，以结束艾滋病毒的传播 通过实现零排放倡议。执行方面出现了挑战，主要挑战是 监测、评估和提供及时反馈，以实现迭代改进 战略为了在有限的资源范围内提高效率，德国技术合作署的工作需要系统地， 定期评估，为成功实施提供反馈-数据驱动的基石 执行科学。发展和组织监测和评价系统得到了承认 作为一个独立的实施策略。显然有必要制定严格的评价方法， 一个实施科学框架，可以为德国技术合作署计划的公共卫生实施者提供明确的， 当代反馈，并作为推动综合护理连续体周期性改善的工具 结果。对于这份职业发展建议书，我将使用探索、准备、实施和 可持续发展（EPIS）模型，以探索与公众合作在伊利诺伊州采用德国技术合作公司的评估工具 健康伙伴。因此，本提案将：1）使用一个执行框架来审查能力， 关键利益攸关方采用各种数据来源评估德国技术合作署消除艾滋病毒工作的准备程度和可行性 努力，2）证明候选数据源在评估中的适当性和可行性 透过个案研究，提供一套完整的照护系统，以及3）发展评估照护系统的工具 通过数据监测和反馈实现连续性。本提案中的知识将填补以下方面的重要空白： 如何以监测、反馈和评估的形式提供针对具体情况的实施支持 在消灭艾滋病毒的多管齐下的司法计划中。由此产生的知识有可能 推动伊利诺伊州和其他司法管辖区的消除工作的服务改进。K奖将 提供实施研究、卫生服务和混合方法方面的高级培训， 我在流行病学和艾滋病预防方面的背景。我将把我的研究经验与 我强大的导师团队，以发展成为独立调查员所需的技能。这些 这些经验将使我成为艾滋病毒预防和实施领域的领导者。

PROJECT SUMMARY In this career development proposal, I aim to use implementation science strategies for evaluation of the integrated care continuum within a Getting to Zero (GTZ) Framework. GTZ frameworks propose expansion and scale-up of effective HIV treatment and prevention interventions such as pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP), with the goal of eliminating new HIV transmission events. GTZ initiatives are most commonly operationalized through integrated care continuums. The integrated care continuum describes HIV care and prevention steps for HIV positive and HIV negative, but susceptible, persons: both critical to ending HIV transmission. Many jurisdictions have undertaken systematic efforts to end HIV transmission through Getting to Zero initiatives. Challenges in implementation have occurred, with a primary one being monitoring, evaluating, and providing timely feedback for iterative improvements in the implementation strategy. In order to be efficient within constrained resources, GTZ efforts need to be systematically and routinely assessed to provide feedback for successful implementation – a data-driven cornerstone of implementation science. Developing and organizing monitoring and evaluation systems has been recognized as a discrete implementation strategy. There is a clear need to develop rigorous methods of evaluation within an implementation science framework that can provide public health implementers of GTZ plans clear and contemporary feedback, and serve as a tool driving cyclical improvements in integrated care continuum outcomes. For this career development proposal, I will use the Exploration, Preparation, Implementation, and Sustainment (EPIS) model to explore adoption of a GTZ evaluation tool in Illinois in collaboration with public health partners. Therefore, this proposal will 1) use an implementation framework to examine capacity, readiness and feasibility of key stakeholders to adopt diverse data sources to evaluate GTZ HIV elimination efforts, 2) demonstrate the appropriateness and feasibility of candidate data sources in evaluating the integrated care continuum through a case example, and 3) develop tools for evaluation of the integrated care continuum through data monitoring and feedback. The knowledge from this proposal will fill important gaps in how to provide context-specific implementation support in the form of monitoring, feedback, and evaluation within multi-pronged jurisdictional programs for HIV elimination. The resulting knowledge has the potential to drive service improvements for elimination efforts both in Illinois and other jurisdictions. This K award will provide advanced training in implementation research, health services, and mixed methods that will build on my background in epidemiology and HIV prevention. I will bring my research experience together with that of my strong mentorship team to develop the skills necessary to become an independent investigator. These experiences will position me to become a leader in the field of HIV prevention and implementation.