HIV care coordination: comparative effectiveness, outcome determinants and costs

艾滋病毒护理协调：比较有效性、结果决定因素和成本

• 批准号: 8659691
• 负责人: Mary Kathryn Irvine
• 金额: $ 51.53万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-26 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8659691
• 关键词: AIDS/HIV problem; Achievement; Aftercare; Alcohol or Other Drugs use; Behavioral; Caring; Case Management; Client; Cohort Studies; Communities; Comprehensive Health Care; Cost Savings; Data; Decision Making; Directly Observed Therapy; Early treatment; Effectiveness; Effectiveness of Interventions; Elements; Eligibility Determination; Enrollment; Epidemic; Funding Agency; Goals; HIV; HIV Infections; HIV diagnosis; Health; Health Benefit; Health Promotion; Home environment; Hospitals; Individual; Intervention; Interview; Learning; Life; Location; Long-Term Care; Mental Health; Mental disorders; Modeling; Outcome; Participant; Patients; Persons; Prevention; Program Effectiveness; Public Health; Public Health Schools; Quality-Adjusted Life Years; Recording of previous events; Relative (related person); Research; Research Personnel; Resources; Sampling; Services; Site; Structure; Subgroup; Test Result; Viral Load result; Virus; Visit; Work; antiretroviral therapy; base; biobehavior; college; comparative effectiveness; comparison group; cost; cost effective; cost effectiveness; effective therapy; evidence base; follow-up; high risk; housing instability; improved; intervention program; meetings; outreach; population based; primary outcome; programs; public health relevance; response; scale up; surveillance data; transmission process; treatment as usual; treatment program; uptake

DESCRIPTION (provided by applicant): Significant gaps in HIV diagnosis rates, linkage to and retention in HIV care, timely antiretroviral therapy (ART) initiation, and viral load (VL) suppression among persons living with HIV (PLWH) undermine the potential impact of 'treatment as prevention' and jeopardize achievement of US National HIV/AIDS Strategy (NHAS) goals. There is a significant need for more rigorous evidence regarding the effectiveness of several promising intervention strategies, some of which are already being implemented alone or in combination. In late 2009, the NYC Department of Health and Mental Hygiene (DOHMH) began implementing a comprehensive Care Coordination Program (CCP) at 28 Ryan White-funded agencies, targeting patients at high risk for suboptimal care cascade outcomes. The CCP intervention combines various evidence-based programmatic elements into a package, including case management, patient navigation, directly observed therapy (DOT), structured health promotion in home/field visits, and outreach to assist patients in accessing needed care and related services. The purpose of this retrospective cohort study, led jointly by investigators from the CUNY School of Public Health at Hunter College and the NYCDOHMH, is to: 1) assess the effectiveness of the CCP intervention by comparing primary outcomes among CCP participants with those of similar PLWH in HIV care who do not receive the CCP intervention; 2) among those who enroll in CCP, identify individual and program-level determinants of care engagement and VL suppression up to 36 months following CCP enrollment; and 3) assess the cost-effectiveness (cost per quality-adjusted life year [QALY]) of the CCP relative to usual care outside the CCP, considering downstream cost-savings and individual and public health benefits due to improved VL suppression and HIV infections averted. We expect the proposed research to generate much- needed evidence related to the effectiveness, outcome determinants, and cost-effectiveness of a promising, scalable service delivery strategy, ultimately enabling HIV care programs to further evolve achieve the greatest possible uptake and impact.

描述（由申请人提供）：HIV诊断率，与HIV护理中的联系和保留率的显着差距，及时的抗逆转录病毒疗法（ART）起始以及HIV（PLWH）患者的病毒载荷（VL）抑制（PLWH）破坏了“预防治疗”的潜在影响，并使我们全国性HIV/AIDS策略（NHAS）的实现（Jeopard）对实现了目标。关于几种有前途的干预策略的有效性，有一个更严格的证据需要更严格的证据，其中一些已经是单独或联合实施的。 2009年底，纽约市卫生与精神卫生部（DOHMH）开始在28个Ryan White资助的机构实施一项全面的护理协调计划（CCP），以次优级联级联级联成果的高风险患者。 CCP干预将各种基于证据的程序化元素结合在一起，包括病例管理，患者导航，直接观察到的治疗（DOT），在家/实地就诊中的结构性健康促进以及宣传以帮助患者获得所需的护理和相关服务。这项回顾性队列研究的目的是由亨特学院公共卫生学院和NYCDOHMH的研究人员共同领导的是：1）评估CCP干预措施的有效性，通过比较CCP参与者中的主要结果与未接受CCP干预的HIV CAR中的CCP参与者之间的主要结果； 2）在加入CCP的人中，确定CCP入学后长达36个月的护理参与度和VL抑制的个人和计划级别的决定因素； 3）考虑到CCP以外的常规护理，评估CCP的成本效益（每个质量调整后的生活年份[QALY]），考虑到下游成本节省以及由于改善了VL抑制和HIV感染而导致的个人和公共健康益处。我们预计拟议的研究能够产生与有希望的，可扩展的服务交付策略的有效性，结果决定因素和成本效益有关的急需证据，最终使艾滋病毒护理计划能够进一步发展实现最大的吸收和影响。