Systems analysis and improvement approach to improve pediatric HIV testing and linkage to care

改善儿科艾滋病毒检测和护理联系的系统分析和改进方法

• 批准号: 9136343
• 负责人: Anjuli Dawn Wagner
• 金额: $ 5.7万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-12-01 至 2019-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9136343
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adult; Africa South of the Sahara; Aggressive course; Anti-Retroviral Agents; Caring; Cessation of life; Characteristics; Child; Childhood; Clinic; Complement; Counseling; Data; Detection; Drops; Engineering; Facility Controls; Growth and Development function; HIV; HIV diagnosis; Health care facility; Health system; High Prevalence; Home environment; Human Resources; Human immunodeficiency virus test; Infection; Intervention; Kenya; Life; Link; Location; Management Information Systems; Maps; Mentors; Methods; Modeling; Morbidity - disease rate; Performance; Pregnancy; Principal Investigator; Process; Randomized Controlled Trials; Research Project Grants; Risk; Services; Site; Surveys; System; Systems Analysis; Testing; Translating; cost; evidence base; experience; flexibility; implementation science; improved; innovation; mortality; pediatric human immunodeficiency virus; pediatric human immunodeficiency virus infection; post intervention; programs; public health relevance; scale up; tool; uptake

 DESCRIPTION (provided by applicant): This implementation science research project aims to evaluate innovative strategies to expand pediatric HIV diagnosis and linkage to care. Over 90% of the 3.2 million HIV-infected children in the world live in sub- Saharan Africa, many of whom are undiagnosed. In the absence of treatment, pediatric HIV has a far more aggressive course than adult infection and the benefits of antiretroviral treatment are limited when treatment is deferred until children are symptomatic. Children born before the scale up of PMTCT programs, and children who slip through the cracks in the PMTCT cascade remain untested and at risk for severe illness and death. Targeted HIV testing for the children of HIV-infected adults in care is an efficient case detection strategy that identifies a high prevalence of pediatric HIV; however, pediatric HIV testing rates remain low. A health systems-level approach to optimizing the delivery and tracking of pediatric HIV testing services in the pediatric HIV testing and care cascade may complement and improve current pediatric HIV diagnosis approaches. This study will 1) identify health facility level factors associated with high and low pediatric HIV testing rates, and 2) adapt and test the Systems Analysis and Improvement Approach (SAIA) previously used to enhance PMTCT (R01, Principal investigator: Sherr) to determine whether it can improve pediatric HIV testing rates and linkage to care. In Aim 1, we will use routinely collected pediatric HIV testing indicator data and remote surveys through a partnership with the National AIDS and STI Control Programme (NASCOP); we will compare high and low pediatric HIV- testing facilities to identify potentially modifiable facility-level characteristics, which ca be evaluated during the adapted SAIA intervention. In Aim 2, we will conduct a cluster randomized controlled trial (cRCT) in Kenya using the 12 sites from the SAIA trial. The SAIA approach involves classical industrial engineering methods- cascade analysis, process mapping, and continuous quality improvement-and has been successful in optimizing PMTCT delivery services. We will collect routine, monthly pediatric HIV testing and linkage to care indicator data for each facility and compare the change in a) testing rates and b) linkage to care between intervention and control facilities during pre-intervention, intervention, and post-intervention periods. If found to be effective and sustainable, this low-cost and flexible intervention may provide a new tool for optimizing pediatric HIV testing and linkage to care.

 描述（由申请人提供）：该实施科学研究项目旨在评估创新策略，以扩大儿科艾滋病毒诊断和护理联系。世界上320万艾滋病毒感染儿童中有90%以上生活在撒哈拉以南非洲，其中许多人未得到诊断。在没有治疗的情况下，儿童艾滋病毒的病程比成人感染更具侵略性，当治疗推迟到儿童出现症状时，抗逆转录病毒治疗的益处有限。在预防母婴传播方案扩大之前出生的儿童，以及在预防母婴传播级联方案的缝隙中溜走的儿童，仍然没有得到检测，有可能患上严重疾病和死亡。对受护理的艾滋病毒感染成人的子女进行有针对性的艾滋病毒检测是一种有效的病例检测策略，可以确定儿童艾滋病毒的高流行率;然而，儿童艾滋病毒检测率仍然很低。在儿科艾滋病毒检测和护理级联中优化儿科艾滋病毒检测服务的交付和跟踪的卫生系统级方法可以补充和改进当前的儿科艾滋病毒诊断方法。本研究将1）确定与高和低儿科HIV检测率相关的卫生设施水平因素，2）调整和测试先前用于增强PMTCT（R 01，主要研究者：Sherr）的系统分析和改进方法（SAIA），以确定它是否可以提高儿科HIV检测率和与护理的联系。在目标1中，我们将通过与国家艾滋病和性传播疾病控制计划（NASCOP）的合作，使用常规收集的儿科艾滋病毒检测指标数据和远程调查;我们将比较高和低儿科艾滋病毒检测设施，以确定潜在的可修改的设施水平特征，这些特征可以在调整后的SAIA干预期间进行评估。在目标2中，我们将使用SAIA试验的12个研究中心在肯尼亚进行一项群集随机对照试验（cRCT）。SAIA方法涉及经典的工业工程方法-级联分析，流程图和持续质量改进-并成功地优化了PMTCT交付服务。我们将收集每月例行的儿科艾滋病毒检测和与护理指标数据的联系 并比较干预前、干预和干预后期间干预和控制机构之间a）检测率和B）与护理的联系的变化。如果发现有效和可持续，这种低成本和灵活的干预措施可能为优化儿科艾滋病毒检测和护理联系提供新的工具。