Managed Problem Solving for ART Adherence and HIV Care Retention Delivered by Community Health Workers: A Stepped Wedge Hybrid Type II Effectiveness Implementation Trial

社区卫生工作者提供的针对 ART 依从性和 HIV 护理保留的管理问题解决：阶梯楔形混合 II 型有效性实施试验

• 批准号: 10432088
• 负责人: Rinad Sary Beidas
• 金额: $ 77.67万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-25 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10432088
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Area; Back; Behavior Therapy; Behavioral; Benchmarking; Caring; Cities; Client; Clinic; Clinical effectiveness; Communication; Community Health Aides; Consolidated Framework for Implementation Research; Continuity of Patient Care; Counseling; County; Data; Decision Making; Dissemination and Implementation; Elements; Ensure; Epidemic; Ethnic Origin; Evidence based practice; Future; Generations; Goals; HIV; HIV Infections; Health Professional; Health system; Hybrids; Incidence; Individual; Intervention; Interview; Language; Life Experience; Link; Medical Care Team; Outcome Measure; Patients; Persons; Philadelphia; Problem Solving; Process; Professional counselor; Protocols documentation; Public Health; Randomized; Research; Services; Socioeconomic Status; Standardization; Testing; Time; Training; Trust; United States; United States National Institutes of Health; Viral; behavior change; cohort; collaborative approach; design; effectiveness implementation trial; effectiveness outcome; effectiveness testing; experience; falls; health belief; implementation cost; implementation efforts; implementation measures; implementation outcomes; implementation process; implementation research; implementation science; implementation strategy; improved; marginalized population; medication compliance; meetings; member; metropolitan; next generation; primary outcome; retention rate; secondary outcome; skills; treatment as prevention; treatment as usual

Project Summary/Abstract To achieve aspirational goals to end the HIV epidemic (EHE), evidence-based practices (EBPs) to increase viral suppression must be implemented effectively nationally. The Managed Problem Solving (MAPS) behavioral intervention is an EBP for behavior change in people living with HIV (PLWH). To accomplish the goals of this application, we leverage a data-to-care partnership between the Philadelphia Department of Public Health (PDPH) and participating clinics (n = 12), which enhances the sustainability of our approach. We propose that MAPS can be delivered by trained Community Health Workers (CHWs). The use of CHWs to deliver MAPS is justified by their ability to develop trusting relationships with their clients and the need for task shifting in busy clinics. In order to also address retention in care, we will adapt MAPS to also focus on problem solving activities tailored toward retention in care (now termed MAPS+). CHWs will be located in clinics to implement MAPS+ to improve viral suppression and care retention in PLWH. Data-to-care allows for identification of people who are lost to care and link these patients back to care. Currently, medication adherence and retention in HIV care are not targeted in data-to-care so we will build on this approach to facilitate the identification of PLWH who are out of care and not virally suppressed to offer them MAPS+. Our set of implementation strategies include task- shifting the delivery of MAPS+ to CHWs, providing the CHWs training and ongoing support, and increasing communication between the CHWs and medical care team via standardized protocols. We will conduct a hybrid type II effectiveness-implementation trial with a stepped-wedge cluster randomized design in 12 clinics to test MAPS+ compared to usual care using a set of implementation strategies that we believe will best support implementation. Each clinic will be randomized to one of three implementation start times. We will collect baseline (usual care) data from each clinic for 6 months, followed by MAPS+ and our package of implementation strategies for 12 months, in three cohorts of 4 clinics each. Aim 1 will test the effectiveness of MAPS+ on clinical effectiveness outcomes, including viral suppression (primary) and retention (secondary). Aim 2 will examine the effect of the package of implementation strategies on reach. We will also measure implementation cost. Aim 3 will apply a qualitative approach to understand processes, mechanisms, and sustainment of our implementation approach. Our results will guide future efforts to implement behavioral EBPs across the HIV care continuum, consistent with the “treat” pillar of EHE, and move the science of implementation services, consistent with NIH strategic priorities.

项目摘要/摘要 为了实现理想的目标以结束艾滋病毒流行（EHE），循证实践（EBP）增加病毒 必须在全国范围内有效实施抑制。托管问题解决（地图）行为 干预是艾滋病毒（PLWH）患者行为改变行为的EBP。实现目标的目标 应用程序，我们利用费城公共卫生部之间的数据与护理伙伴关系 （PDPH）和参与诊所（n = 12），可以增强我们方法的可持续性。我们提出了这一点 地图可以由训练有素的社区卫生工作者（CHW）提供。使用CHW提供地图是 通过他们与客户建立信任关系的能力以及在忙碌中进行任务转移的需求是合理的 诊所。为了解决护理中的保留率，我们将适应地图，也将重点放在解决问题的活动上 针对保留保留量量身定制（现在称为地图+）。 CHW将位于诊所中以实现地图+ 改善PLWH中的病毒抑制和护理保留率。数据到保健允许确定是 迷失了护理，并将这些患者联系起来。目前，艾滋病毒护理中的药物依从性和保留率是 不是针对数据到保健的目标 护理，几乎没有被压制以提供地图+。我们的一套实施策略包括任务 - 将地图+的交付交付转移到CHW，提供CHWS培训和持续的支持，并增加 CHW和医疗团队之间通过标准化协议进行沟通。我们将进行混合 II型有效性实施试验，在12个诊所进行阶梯式悬挂群集随机设计进行测试 与通常使用一套实施策略相比，地图+与通常的护理相比 执行。每个诊所将被随机分为三个实施开始时间之一。我们将收集基线 （通常的护理）每个诊所的数据持续6个月，然后是地图+和我们的实施套餐 策略12个月，在三个队列中分别四个诊所中。 AIM 1将测试地图+对临床的有效性 有效性结果，包括病毒抑制（原发性）和保留率（次要）。 AIM 2将检查 实施策略包裹的影响。我们还将衡量实施成本。目标3 将采用定性方法来了解我们实施的过程，机制和维持 方法。我们的结果将指导未来的努力，以实施整个HIV护理连续体的行为EBP， 与EHE的“治疗”支柱一致，并移动实施服务科学，与NIH一致 战略重点。