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