Implementation Science of a Data-to-Care Strategy to Improve HIV Continuum and Drug Treatment Outcomes for Out of Care PLWH in Ukraine

数据到护理策略的实施科学，以改善乌克兰非护理艾滋病毒感染者的艾滋病毒连续体和药物治疗结果

• 批准号: 10463563
• 负责人: Kostyantyn Dumchev
• 金额: $ 22.22万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10463563
• 关键词: AIDS/HIV problem; Address; Adherence; Adoption; Affect; Appointment; Area; Caring; Case Management; Characteristics; Client; Climate; Clinic; Clinical; Clinical Data; Clinical Management; Complement; Complex; Consolidated Framework for Implementation Research; Continuity of Patient Care; Cost Analysis; Data; Decision Making; Diagnosis; Drops; Drug Prescriptions; Eastern Europe; Effectiveness; Enrollment; Evaluation; Evidence based intervention; Evidence based practice; Goals; HIV; HIV Seropositivity; HIV diagnosis; Health; Individual; Infrastructure; Injecting drug user; Institutes; International; Intervention; Interview; Laboratories; Medical; Medical Surveillance; Mental Health; National Institute of Drug Abuse; Organizational Policy; Outcome; Participant; Patient Care; Patients; Persons; Pharmacotherapy; Policies; Positioning Attribute; Practice Management; Process; Provider; Psychosocial Assessment and Care; Psychosocial Factor; Public Health; Randomized Clinical Trials; Randomized Controlled Trials; Research; Research Priority; Services; Site; Social Work; System; Test Result; Testing; Treatment outcome; USAID; Ukraine; United States; Viral; Vulnerable Populations; addiction; ancillary care; care outcomes; care providers; care systems; comorbidity; cost effectiveness; data integration; data management; effectiveness evaluation; experience; implementation science; implementation strategy; improved; interest; intravenous drug use; low and middle-income countries; medical information system; medication compliance; multiple data sources; organizational structure; primary outcome; programs; scale up; secondary outcome; service utilization; standard of care; substance abuse treatment; substance use; surveillance data

The goal of this project is to develop and pilot a data-to-care strategy to improve HIV care outcomes among not-in-care PLWH in Ukraine. Data-to-Care (D2C) is a high-impact public health strategy that integrates multiple sources of data such as clinical data from medical information systems, surveillance data, and ongoing case management assessments with clients to identify PLWH who are not in care, engage them in care, and manage the HIV Care Continuum. D2C strategies complement evidence-based practices for HIV care adherence by integrating clinical and case management data at multiple points along the HIV care continuum, using systematic assessments to identify unmet needs such as substance abuse treatment and make appropriate care referrals, and using data to inform practice changes and improve linkage to and retention in care. D2C strategies have been effectively implemented in jurisdictions throughout the United States but are not standard of care in low- and middle-income countries (LMICs) such as Ukraine. In Ukraine, of the approximately 244,000 estimated people living with HIV in Ukraine, only 44% are receiving ART. At least 50% of PLWH in Ukraine acquired HIV though intravenous drug use and are likely to be active people who inject drugs (PWID). ART use rates are particularly low among HIV-positive PWID, with only 38% on ART and 28% virally suppressed. This study’s Specific Aims are: (1) to adapt and develop a D2C implementation strategy for Ukraine; (2) to pilot a randomized clinical trial of a D2C strategy versus standard of care; and (3) to assess the feasibility, acceptability, and implementation-related processes and outcomes of the D2C strategy. We will use a cluster randomized control trial in PEPFAR-designated high priority regions in Ukraine (4 clinical settings and 160 total participants). Main outcomes of interest are: engagement/re-engagement in HIV care, MAT and other ancillary care service; ART initiation/re-initiation; and viral suppression. Outcomes will be assessed at 6 and 12- months post-baseline. Ukraine is well-positioned as a site to identify how D2C strategies can be implemented in LMICs. With the support of international stakeholders such as PEPFAR, the Ukrainian Ministry of Health is actively promoting the use of a medical information system (MIS) at the HIV clinic level. The MIS contains patient-level information on HIV care appointments kept, medication prescriptions, all diagnosed co- morbidities, and clinical and laboratory test results. This information can be mobilized in a D2C strategy that tracks patients through the care continuum, uses data to make decisions about patient care and improve case management practices, attends to psychosocial factors that affect medication adherence (e.g., mental health, addiction), and coordinates the provision of non-clinical social services. This project seeks to develop and test an intervention that influence organizational structure, climate, and culture to promote dissemination and adoption of evidence-based practices; and evaluate the adaptation process, and subsequent effectiveness of evidence-based interventions when implemented in real-world settings.

该项目的目标是制定和试行一项从数据到护理的战略，以改善艾滋病毒护理成果