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， 乌克兰的无照料艾滋病病毒携带者。数据到护理（D2C）是一项具有高度影响力的公共卫生战略， 多个数据源，如来自医疗信息系统的临床数据、监测数据和正在进行的 对客户进行个案管理评估，以确定没有接受护理的艾滋病毒携带者和艾滋病患者，让他们参与护理， 管理艾滋病毒护理连续体。D2C战略补充了艾滋病毒护理的循证实践 通过在艾滋病毒护理连续体沿着多个点整合临床和病例管理数据， 利用系统评估来确定未满足的需求，如药物滥用治疗， 适当的护理转介，并利用数据为实践变化提供信息，并改善与 在乎D2C策略已经在美国各地的司法管辖区有效实施，但 而不是乌克兰等中低收入国家的标准护理。在乌克兰， 乌克兰估计约有244，000名艾滋病毒感染者，但只有44%接受了抗逆转录病毒治疗。至少50% 乌克兰的艾滋病毒携带者通过静脉注射毒品获得艾滋病毒， 药物（PWID）。在艾滋病毒阳性的艾滋病患者中，抗逆转录病毒疗法的使用率特别低，只有38%的人接受抗逆转录病毒疗法，28%的人接受抗逆转录病毒疗法。 病毒被抑制本研究的具体目标是：（1）适应和发展D2C的实施策略， 乌克兰;（2）试点D2C策略与标准护理的随机临床试验;（3）评估 D2C战略的可行性、可接受性和实施相关流程和结果。我们将使用 在PEPFAR指定的乌克兰高优先地区进行的一项群集随机对照试验（4个临床环境， 共160人）。关注的主要成果是：参与/重新参与艾滋病毒护理、MAT和其他 辅助护理服务;抗逆转录病毒疗法启动/重新启动;和病毒抑制。结果将在6时进行评估， 12-基线后月。乌克兰是一个很好的定位，以确定如何D2C战略可以 在中低收入国家实施。在PEPFAR等国际利益攸关方的支持下，乌克兰外交部 卫生部正在积极推动在艾滋病毒诊所一级使用医疗信息系统。的MIS 包含关于艾滋病毒护理预约、药物处方、所有诊断出的合并症、 发病率以及临床和实验室测试结果。该信息可以在D2C策略中被调动， 通过护理连续体跟踪患者，使用数据做出有关患者护理的决策并改善病例 管理实践，关注影响药物依从性的社会心理因素（例如，心理健康， 成瘾），并协调提供非临床社会服务。该项目旨在开发和测试 影响组织结构、氛围和文化的干预措施，以促进传播和 采用循证实践;并评估适应过程和随后的有效性， 在现实世界中实施的循证干预措施。