A type 2 hybrid effectiveness-implementation trial to evaluate a population health combination intervention to meet HIV testing, linkage, and viral suppression goals in coastal Alabama

一项 2 型混合有效性实施试验，旨在评估人口健康组合干预措施，以实现阿拉巴马州沿海地区的 HIV 检测、关联和病毒抑制目标

• 批准号: 10461324
• 负责人: Lynn T Matthews
• 金额: $ 82.01万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10461324
• 关键词: Acquired Immunodeficiency Syndrome; Administrator; Adult; Affect; Alabama; Area; Attitude; Big Data; Caring; Centers for Disease Control and Prevention (U.S.); Client; Clinic; Clinical; Clinical effectiveness; Code; Collaborations; Communities; Consolidated Framework for Implementation Research; County; Data; Data Set; Deep South; Diagnosis; Diagnostic; Effectiveness; Epidemic; Evaluation; Evidence based intervention; Federally Qualified Health Center; Funding; Future; Geography; Goals; HIV; HIV diagnosis; Health; Health Service Area; Health system; Human immunodeficiency virus test; Incidence; Individual; Intervention; Interview; Learning; Link; Maintenance; Mission; Newly Diagnosed; Outcome; Persons; Population; Population Decreases; Positioning Attribute; Poverty; Prevalence; Process; Provider; Public Health; Qualitative Methods; Reach Effectiveness Adoption Implementation and Maintenance; Research; Research Personnel; Rural; Surveys; System; Techniques; Testing; Time; United States; United States Dept. of Health and Human Services; Universities; Viral; Work; antiretroviral therapy; base; care systems; clinical implementation; community clinic; concept mapping; effectiveness implementation study; effectiveness implementation trial; effectiveness outcome; effectiveness study; experience; formative assessment; implementation evaluation; implementation outcomes; implementation strategy; implementation trial; improved; innovation; meetings; novel; outreach; population health; prevention service; programs; racial disparity; rural counties; social stigma; surveillance data; tool

Abstract This proposal describes a 5-year research plan to adapt and evaluate implementation of three evidence-based interventions to achieve the goals of Ending the HIV Epidemic (EHE) in Alabama (AL). This combination intervention will (1) use novel big data approaches to inform precision public health efforts to increase testing in priority populations, (2) decrease time to linkage to care, and (3) decrease time to viral suppression (VS) among persons newly diagnosed with HIV in AL, a priority state in the national EHE Initiative. The proposal leverages a dynamic and innovative collaboration of experienced investigators from the University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR) and the HIV Divisions of the state health department in AL (ADPH) and the Mobile County Health Department (MCHD). The MCHD serves six predominantly rural counties in the southwestern region of AL with low testing coverage, high incidence, and suboptimal times to linkage and VS for newly diagnosed cases of HIV. We propose a type 2 hybrid implementation-effectiveness study guided by the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks to adapt, implement, and evaluate three Centers for Disease Control (CDC) evidence-based interventions: (1) a data-driven approach to direct Community-based HIV testing in areas with low testing coverage, (2) Project Connect, to expedite linkage at time of diagnosis and (3) a Rapid ART start program at MCHD community clinics in Alabama (“COAST-AL”). In Aim 1, we will use qualitative methods to adapt COAST-AL combination intervention to the local context. In Aim 2, we will deploy the adapted intervention across MCHD services areas over 36 months. Our primary effectiveness outcome is days to VS after HIV diagnosis using state-level surveillance data from ADPH. Our primary implementation outcome is proportion of zip code tabulation areas with at least 15% of the adult population tested by 36 months compared to baseline using surveillance and commercial HIV testing data sets. We will evaluate intervention acceptability, feasibility, appropriateness from clients through in-depth interviews and with providers through surveys. In Aim 3 we will conduct interviews with key stakeholders and work collaboratively with local and state health department stakeholders to identify and prioritize implementation strategies that can be deployed to sustain COAST-AL and facilitate its implementation in other public health jurisdictions across AL and other rural EHE-prioritized states. Results of this research will lay the groundwork for a larger implementation trial that will include rigorous evaluation of implementation strategies to integrate COAST-AL into clinical and public health systems to meet EHE targets.

摘要 该提案描述了一个5年研究计划，以适应和评估三个 以证据为基础的干预措施，以实现目标，结束艾滋病毒流行病（EHE）在亚拉巴马（AL）。 这种组合干预将（1）使用新的大数据方法为精准公共卫生提供信息 努力增加优先人群的检测，（2）减少与护理联系的时间，（3）减少 AL中新诊断的HIV感染者的病毒抑制时间（VS）， 国家EHE倡议。该提案利用了经验丰富的 来自伯明翰亚拉巴马大学艾滋病研究中心的研究人员 以及AL州卫生部艾滋病毒司（ADPH）和移动的县卫生部 部门（MCHD）。MCHD服务于西南地区的六个主要农村县 AL的低检测覆盖率，高发病率，以及对新的连锁和VS的次优时间 艾滋病确诊病例。我们提出了一个类型2混合实施效果研究的指导下， 实施研究综合框架（CFIR）和覆盖范围，有效性，采用， 实施和维护（RE-AIM）框架，以适应，实施和评估三个 疾病控制中心（CDC）的循证干预措施：（1）数据驱动的方法，以直接 在检测覆盖率低的地区开展基于社区的艾滋病毒检测，（2）“连接项目”，以加快 在诊断时的联系和（3）在亚拉巴马的MCHD社区诊所的快速ART启动计划 （“COAST-AL”）。在目标1中，我们将使用定性方法来适应COAST-AL组合干预 to the local本地context上下文.在目标2中，我们将在MCHD服务领域部署适应性干预措施 超过36个月。我们的主要有效性结果是使用州一级艾滋病毒诊断后的VS天数 ADPH的监测数据。我们的主要实施成果是邮政编码的比例制表 与基线相比，36个月时至少有15%的成年人接受了测试， 监测和商业艾滋病毒检测数据集。我们将评估干预的可接受性， 通过深入访谈，从客户那里了解可行性和适当性，并通过调查与供应商进行交流。 在目标3中，我们将与关键利益相关者进行访谈，并与地方和州合作 卫生部门利益相关者确定可部署的实施战略并确定其优先次序 维持COAST-AL并促进其在AL其他公共卫生管辖区的实施， 其他农村EHE优先国家。这项研究的结果将为更大规模的 执行试验将包括严格评价执行战略， COAST-AL纳入临床和公共卫生系统，以实现EHE目标。