Optimizing Care Delivery to Support Reengagement in PLWH Returning to HIV Care after Treatment Lapses in Zambia
优化护理服务,支持赞比亚治疗失败后重新接受艾滋病毒感染者护理
基本信息
- 批准号:10484440
- 负责人:
- 金额:$ 21.17万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-08-10 至 2025-07-31
- 项目状态:未结题
- 来源:
- 关键词:AddressAdherenceAfrica South of the SaharaAftercareAttitudeBackBehaviorCaringClinicClinicalCluster randomized trialCollaborationsCounselingDataDevelopmentDrug resistanceEffectivenessEnsureFeedbackFocus GroupsFoundationsFutureHIVHealthHealth PersonnelHealth systemHomeHumanIndividualInfectious Diseases ResearchInterruptionInterventionInterviewLeadLeadershipLife ExperienceMethodsMonitorMorbidity - disease rateNursesOutcomePatient CarePatient-Focused OutcomesPatientsPersonsPhysiciansProcessProtocols documentationProviderPsychosocial FactorQualitative MethodsReportingResearchResearch InfrastructureResearch PersonnelRuralServicesStructureTestingTimeTrainingTravelUniversitiesViralViral Load resultViremiaWashingtonZambiabehavior changecare deliverycritical perioddesigneffectiveness implementation studyevidence baseexperienceexperimental studyfollow-uphigh riskhigh risk populationhuman centered designimplementation evaluationimplementation frameworkimplementation strategyimprovedimproved outcomemortalitypatient populationpeerpreferencepreventprogramsprototypepublic health prioritiesresponseservice deliverytransmission process
项目摘要
ABSTRACT
Sustained retention in HIV care is critical for viral suppression, but people living with HIV (PLWH) frequently
transition in and out of care over time, putting them at high risk for ongoing viremia and drug resistance. Even
when PLWH return to care after loss to follow-up (LTFU), rates of becoming LTFU again in the future are very
high. Our preliminary data from Zambia suggests that 30% become LTFU again within 6 months, and that 50%
of those who are currently LTFU have previously cycled in and out of care. The time of reengagement in care is
thus a critical period to intervene in this high-risk population, and strategies to improve post-return care delivery
are urgently needed to break ongoing cycles of disengagement. After returning to care, PLWH often report being
scolded, health care workers (HCW) delay ART re-initiation due to adherence concerns and do not consistently
monitor virologic response, and PLWH likely still experience the life situations (e.g., competing obligations, travel
away from home, or psychosocial factors) that led to their initial LTFU. Strategies to 1) target HCW behaviors
(i.e., welcoming returning patients, prompt ART re-initiation) using implementation strategies such as practice
facilitation and audit and feedback and 2) offer PLWH support services tailored to their initial reasons for LTFU
(e.g., extended refills, transfer coordination, peer-navigation) may be promising. To be successful, however, we
need to understand how to effectively implement these approaches into existing care, including 1) how to engage
HCWs in attitude- and behavior-change strategies, 2) what support services to prioritize for different barriers,
and 3) how to integrate activities into existing workflows. This R34 proposal will build the necessary foundation
for implementing a multicomponent reengagement strategy to support sustained reengagement after returning
to HIV care. In Aim 1a, we assess patient and HCW needs and preferences for reengagement strategies with
patient semi-structured interviews (n=20) and focus group discussions with HCWs and clinic leadership (4 FGDs,
n=8-10 each). In Aim 1b, we conduct discrete choice experiments (200 PLWH, 100 HCWs) to quantify relative
preferences for the contents and attributes for our reengagement strategy. In Aim 2, we undertake a human-
centered design process that engages key stakeholders (PLWH, HCWs, clinic leadership, Ministry of Health) in
co-developing the content and features of a multicomponent reengagement strategy focused on 1) improving
the patient reengagement experience, 2) optimizing ART re-initiation and viral load monitoring post-return, and
3) providing tailored services that target individuals’ specific reasons for LTFU. In Aim 3, we will pilot the
developed strategy at one urban and one rural clinic in Lusaka, Zambia. We will use a mixed-methods approach
to assess the implementation (e.g., acceptability, appropriateness), service delivery (e.g., time to ART re-
initiation, viral load monitoring), and clinical outcomes (e.g., retention and viral suppression at 6 months post-
return). Results from this proposal will directly inform a future R01 to formally test this health-system intervention
for patients reengaging in HIV care in a Type II hybrid implementation-effectiveness cluster randomized trial.
摘要
持续保留艾滋病毒护理对抑制病毒至关重要,但艾滋病毒携带者(PLWH)经常
随着时间的推移,进入和退出护理的过渡,使他们处于持续的病毒血症和耐药性的高风险中。连
当PLWH失去随访后恢复护理(LTFU)时,未来再次成为LTFU的比率非常高
很高。我们来自赞比亚的初步数据显示,30%的人在6个月内再次成为LTFU,50%的人
目前在LTFU的人中,有过骑自行车进出护理的人。重新参与护理的时间是
因此,这是干预这一高危人群的关键时期,也是改善返乡后护理提供情况的战略
这是打破目前脱离接触循环的迫切需要。在返回护理后,PLWH经常报告说
受到斥责,医护人员(HCW)出于对坚持的担忧推迟了ART的重新启动,并且不一致
监测病毒学反应,PLWH可能仍然经历生活状况(例如,相互竞争的义务、旅行
离家出走,或心理社会因素),导致了他们最初的LTFU。1)针对HCW行为的策略
(例如,欢迎返回的患者,迅速重新启动抗逆转录病毒治疗)使用诸如实践等实施战略
促进、审核和反馈,以及2)提供针对LTFU初始原因的PLWH支持服务
(例如,扩展充值、转移协调、对等导航)可能是有希望的。然而,为了取得成功,我们
需要了解如何将这些方法有效地实施到现有护理中,包括1)如何参与
卫生工作者在态度和行为改变策略中,2)针对不同障碍确定优先服务的支持,
以及3)如何将活动集成到现有工作流中。这份R34提案将奠定必要的基础
实施多组件重新参与战略,以支持回国后持续的重新参与
爱滋病护理。在目标1a中,我们评估患者和HCW对重新参与策略的需求和偏好
患者半结构化访谈(n=20)和与卫生工作者和临床领导层的焦点小组讨论(4个FGD,
N=8-10)。在目标1b中,我们进行离散选择实验(200个PLWH,100个HCW)来量化相对
我们重新参与策略的内容和属性的首选项。在《目标2》中,我们承担了一个人类-
以设计为中心的流程,吸引关键利益相关者(公共卫生部门、卫生部门、诊所领导、卫生部)参与
共同开发侧重于1)改进的多组件重新参与战略的内容和特点
患者重新参与的体验,2)优化ART重新启动和返回后的病毒载量监测,以及
3)针对个人LTFU的具体原因提供量身定制的服务。在目标3中,我们将试行
在赞比亚卢萨卡的一家城市诊所和一家乡村诊所制定了战略。我们将使用混合方法
评估实施情况(如可接受性、适当性)、服务交付情况(如重新开展工作的时间)
开始、病毒载量监测)和临床结果(例如,6个月后的滞留和病毒抑制)
返回)。这项提案的结果将直接通知未来的R01,以正式测试这种卫生系统干预
对于在II型混合实施-有效性分组随机试验中重新参与艾滋病毒护理的患者。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
数据更新时间:{{ journalArticles.updateTime }}
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
数据更新时间:{{ journalArticles.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ monograph.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ sciAawards.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ conferencePapers.updateTime }}
{{ item.title }}
- 作者:
{{ item.author }}
数据更新时间:{{ patent.updateTime }}
Aaloke Mody其他文献
Aaloke Mody的其他文献
{{
item.title }}
{{ item.translation_title }}
- DOI:
{{ item.doi }} - 发表时间:
{{ item.publish_year }} - 期刊:
- 影响因子:{{ item.factor }}
- 作者:
{{ item.authors }} - 通讯作者:
{{ item.author }}
{{ truncateString('Aaloke Mody', 18)}}的其他基金
Optimizing Care Delivery to Support Reengagement in PLWH Returning to HIV Care after Treatment Lapses in Zambia
优化护理服务,支持赞比亚治疗失败后重新接受艾滋病毒感染者护理
- 批准号:
10681459 - 财政年份:2022
- 资助金额:
$ 21.17万 - 项目类别:
相似海外基金
An innovative, AI-driven prehabilitation platform that increases adherence, enhances post-treatment outcomes by at least 50%, and provides cost savings of 95%.
%20创新、%20AI驱动%20康复%20平台%20%20增加%20依从性、%20增强%20治疗后%20结果%20by%20at%20至少%2050%、%20和%20提供%20成本%20节省%20of%2095%
- 批准号:
10057526 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Grant for R&D
Improving Repositioning Adherence in Home Care: Supporting Pressure Injury Care and Prevention
提高家庭护理中的重新定位依从性:支持压力损伤护理和预防
- 批准号:
490105 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Operating Grants
I-Corps: Medication Adherence System
I-Corps:药物依从性系统
- 批准号:
2325465 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Standard Grant
Unintrusive Pediatric Logging Orthotic Adherence Device: UPLOAD
非侵入式儿科记录矫形器粘附装置:上传
- 批准号:
10821172 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Nuestro Sueno: Cultural Adaptation of a Couples Intervention to Improve PAP Adherence and Sleep Health Among Latino Couples with Implications for Alzheimer’s Disease Risk
Nuestro Sueno:夫妻干预措施的文化适应,以改善拉丁裔夫妇的 PAP 依从性和睡眠健康,对阿尔茨海默病风险产生影响
- 批准号:
10766947 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
CO-LEADER: Intervention to Improve Patient-Provider Communication and Medication Adherence among Patients with Systemic Lupus Erythematosus
共同领导者:改善系统性红斑狼疮患者的医患沟通和药物依从性的干预措施
- 批准号:
10772887 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Pharmacy-led Transitions of Care Intervention to Address System-Level Barriers and Improve Medication Adherence in Socioeconomically Disadvantaged Populations
药房主导的护理干预转型,以解决系统层面的障碍并提高社会经济弱势群体的药物依从性
- 批准号:
10594350 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Antiretroviral therapy adherence and exploratory proteomics in virally suppressed people with HIV and stroke
病毒抑制的艾滋病毒和中风患者的抗逆转录病毒治疗依从性和探索性蛋白质组学
- 批准号:
10748465 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Improving medication adherence and disease control for patients with multimorbidity: the role of price transparency tools
提高多病患者的药物依从性和疾病控制:价格透明度工具的作用
- 批准号:
10591441 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Development and implementation of peer-facilitated decision-making and referral support to increase uptake and adherence to HIV pre-exposure prophylaxis in African Caribbean and Black communities in Ontario
制定和实施同行协助决策和转介支持,以提高非洲加勒比地区和安大略省黑人社区对艾滋病毒暴露前预防的接受和依从性
- 批准号:
491109 - 财政年份:2023
- 资助金额:
$ 21.17万 - 项目类别:
Fellowship Programs














{{item.name}}会员




