Scaling Low-Barrier Care to Engage People with Complex Needs in HIV Treatment

扩大低门槛护理，让有复杂需求的人参与艾滋病毒治疗

• 批准号: 10460853
• 负责人: Julia Cook Dombrowski
• 金额: $ 73.74万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-09 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10460853
• 关键词: Acquired Immunodeficiency Syndrome; Address; Americas; Assessment tool; Caring; Cities; Clinic; Clinic Visits; Cohort Studies; Collaborations; Communities; Complex; Country; County; Data; Education; Effectiveness; Electronic Health Record; Enrollment; Epidemic; Equation; Evidence based intervention; Focus Groups; Funding; Goals; HIV; HIV diagnosis; Health; Improve Access; Incentives; Individual; Intervention; Interview; Investigation; Maintenance; Measures; Medical; Mental disorders; Methods; Modification; Neighborhood Health Center; Outcome; Persons; Phase; Policies; Population; Primary Health Care; Public Health; Reach Effectiveness Adoption Implementation and Maintenance; Reporting; Research; Structure; Territoriality; United States; Universities; Viral; Viral Load result; Viremia; Vulnerable Populations; Walking; Washington; Work; barrier to care; base; care coordination; cohort; cost; design; evidence base; health care service organization; housing instability; implementation strategy; improved; informant; microcosting; multi-component intervention; population based; programs; prospective; public health relevance; recruit; scale up; secondary analysis; service coordination; social; social health determinants; substance use; surveillance data; tool

Engaging the most vulnerable people with HIV in treatment is central to efforts to end the HIV epidemic. Low- barrier care (LBC) is an evidence-based multicomponent intervention that includes walk-in access to medical care, incentives for clinic visits and viral suppression, intensive support to address social determinants of health, and multisectoral service coordination. The Max Clinic in Seattle is a flagship LBC clinic that has substantially improved viral suppression among people with complex barriers to care, including unstable housing, substance use, and mental health disorders. Expanding LBC is central to the Ending the HIV Epidemic (EHE) plan in King County, Washington. The overall goals of this 5-year proposal are to study LBC expansion in King County, identify factors that facilitate LBC implementation, and prepare for the intervention’s scale-up in other EHE jurisdictions. The team will employ a multifaceted implementation strategy to establish and improve two new LBC clinics in addition to the Max Clinic. We will use the Reach, Effectiveness, Adoption, Implementation & Maintenance (RE-AIM) framework and structured tools to assess intervention adaptation and scalability. For Aim 1, we will evaluate the reach and effectiveness of LBC expansion in King County using a population-based observational open cohort design. For Aim 2, we will describe the implementation and maintenance of LBC in King County, including intervention adaptations, organizational strategies to overcome barriers, and costs. Using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), we will conduct focus group discussions with key stakeholders in the LBC clinics and the health department at baseline and conduct brief re- assessments in six-month intervals over four years to describe intervention adaptations and elucidate implementation and maintenance strategies. We will quantify the costs of LBC expansion from the health department and healthcare organization perspectives using micro-costing methods. For Aim 3, we will assess the scalability of the LBC intervention and identify a consortium of health department and clinic leaders to scale- up LBC in cities and states prioritized for the first phase of EHE funding throughout the U.S. We will partner with NASTAD (the National Association of State & Territorial AIDS Directors) to identify health department HIV program leaders supportive of LBC implementation, and in collaboration with them, recruit leaders of Ryan White-funded HIV Clinics or Community Health Center clinics. We will conduct in in-depth interviews with both the health department and clinic leaders using the Intervention Scalability Assessment Tool (ISAT) for applied assessment of LBC implementation considerations in each local context. Expected Outcome: Our results will guide optimization of LBC implementation, inform intervention adaptations, and lay the groundwork for strategic scale-up of LBC in other parts of the country, which will in turn, advance progress toward achieving EHE goals.

让最脆弱的艾滋病毒携带者接受治疗是结束艾滋病毒流行努力的核心。低- 屏障护理(LBC)是一种基于证据的多成分干预措施，包括无需预约即可获得医疗服务 护理，鼓励就诊和抑制病毒，为解决健康的社会决定因素提供密集支持， 和多部门服务协调。西雅图的Max诊所是LBC的旗舰诊所，拥有大量 改善了对护理有复杂障碍的人的病毒抑制，包括不稳定的住房，物质 使用，和精神健康障碍。扩大LBC是金市结束艾滋病毒流行(EHE)计划的核心 华盛顿州的县。这项为期5年的计划的总体目标是研究金县的LBC扩张， 确定促进LBC实施的因素，并为干预措施在其他EHE中的扩大做好准备 司法管辖区。该小组将采用多方面实施战略，以建立和改进两个新的LBC 除麦克斯诊所外，还有其他诊所。我们将利用覆盖范围、有效性、采用率、实施和 维护(RE-AIM)框架和结构化工具，以评估干预、适应和可伸缩性。为了达到目标 1，我们将评估LBC在金县的覆盖范围和效果，使用基于人口的 观察性开放队列设计。对于目标2，我们将描述LBC的实现和维护 金县，包括干预适应、克服障碍的组织战略和成本。vbl.使用 调整和修改报告框架-增强(FRAME)，我们将进行焦点小组 与LBC诊所的主要利益相关者和卫生部门进行基线讨论，并进行简短的重新 在四年中每隔六个月进行一次评估，以描述干预适应并阐明 实施和维护策略。我们将从健康角度量化LBC扩展的成本 使用微观成本计算方法的部门和医疗保健组织的观点。对于目标3，我们将评估 LBC干预的可扩展性，并确定一个由卫生部门和诊所负责人组成的财团来扩展- 城市和州的Up LBC优先用于全美EHE第一阶段的资金。我们将与 NASTAD(全国州和地区艾滋病局长协会)识别卫生部门艾滋病毒 支持LBC实施的计划领导人，并与他们合作，招募Ryan的领导人 白人资助的艾滋病毒诊所或社区卫生中心诊所。我们将对这两个人进行深入采访 卫生部门和诊所领导使用应用的干预可伸缩性评估工具(ISAT) 评估每个地方背景下的LBC实施考虑因素。预期结果：我们的结果将 指导LBC实施优化，告知干预适应情况，为战略制定奠定基础 扩大LBC在该国其他地区的规模，这将反过来推动实现EHE目标的进展。