Using MOST to optimize an HIV care continuum intervention for vulnerable populations

使用 MOST 优化针对弱势群体的 HIV 护理连续干预

基本信息

批准号：
9301510
负责人：
LINDA M COLLINS
金额：
$ 137.04万
依托单位：
NEW YORK UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-07-01 至 2021-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9301510
关键词：
AIDS prevention AIDS/HIV problem Address Adherence Adult African American Age Alcohol or Other Drugs use Area Behavioral Biological Markers Caring Clinic Continuity of Patient Care Discipline of Nursing Engineering Enrollment Experimental Designs Fright Funding Future HIV Hair Health Care Costs Hybrids Individual Intervention Intervention Studies Latino Literature Mediator of activation protein Medical Records Mental Health Mentorship Methods Morbidity - disease rate NIH Office of AIDS Research Nurses Participant Patients Performance Persons Population Preparation Prevention Primary Health Care Public Health Randomized Randomized Controlled Trials Recording of previous events Recruitment Activity Research Research Methodology Research Priority Resources Risk Factors Sampling Science Scientist Self Determination Services Signal Transduction Support Groups Testing Time Treatment Efficacy Triad Acrylic Resin United States National Institutes of Health Viral Viral Load result Vulnerable Populations antiretroviral therapy behavior change college community setting cost effective cost effectiveness design effective intervention ethnic health disparity experience innovation interest intrinsic motivation mathematical model men who have sex with men mortality motivational enhancement therapy multi-component intervention peer primary outcome public health relevance racial and ethnic racial and ethnic disparities secondary outcome sexual minority social social cognitive theory social stigma theories therapy adherence transmission process

项目摘要

DESCRIPTION (provided by applicant): More than half of persons living with HIV/AIDS (PLHA) in the U.S. are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans and Latinos. In the proposed project, two experienced and productive behavioral scientists will employ a potent and innovative research methodology, the Multiphase Optimization STrategy (MOST), to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials (RCTs) are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American and Latino PLHA not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. This efficiency and cost-effectiveness are critical in a time of constrained resources, and will also increase the intervention's future scalability. NIH has signaled its interest in MOST, and this is the first study to apply it in the ield of adult HIV treatment. A similar set of multi-level factors impede both HIV care and ART initiation for African American and Latino PLHA, primary among them individual (e.g., substance use, distrust, fear), social (e.g., stigma), and structural-level barriers (e.g., difficulties accesing ancillary services). Guided by a multi-level social cognitive theory, the study will evaluate 5 distinct intervention components (i.e., Motivational Interviewing sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study. Study aims are: 1) using a highly efficient experimental design, identify which of 5 components contribute meaningfully to improvement in viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American and Latino PLHA (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N=512). This highly innovative and significant study, which addresses a high- priority research area (NIH NOT-OD-15-137), will produce an HIV care continuum intervention for the nation's most vulnerable PLHA, optimized for cost-effectiveness, and with exceptional levels of efficacy, efficiency, and scalability.

描述（由适用提供）：在美国，超过一半的艾滋病毒/艾滋病（PLHA）患者不足以从事艾滋病毒初级保健，不接受抗逆转录病毒疗法（ART），主要是非裔美国人和拉丁美洲人。在拟议的项目中，两名经验丰富的和产品行为科学家将采用潜在和创新的研究方法，即多相优化策略（大多数），以开发高效，高效，可扩展性，可扩展性和成本效益的干预措施，以增加HIV护理的参与度。尽管随机对照试验（RCT）对于评估多组分干预措施作为包装的有效性很有价值，但它们并非旨在评估哪些特定组件有助于有效性。大多数是一个开创性的，以工程为灵感的框架，通过高效的随机实验来解决此问题，以评估单个干预组件及其相互作用的性能。我们建议大多数人用于设计干预措施，以增加对非裔美国人和拉丁裔PLHA的艾滋病毒护理连续体的参与度，而不是很好地从事护理和不采用艺术。此外，干预措施将用于成本效益。在资源限制时，这种效率和成本效益至关重要，也将提高干预措施的未来可扩展性。 NIH在大多数人中都签署了其兴趣，这是第一个将其应用于成人艾滋病毒治疗的研究。一组类似的多层次因素妨碍了非裔美国人和拉丁裔PLHA的艾滋病毒护理和艺术倡议，其中包括个人（例如，药物使用，不信任，恐惧），社会（例如污名化）和结构性层面的障碍（例如，难以访问辅助服务）。在多层次的社会认知理论的指导下，该研究将评估5个不同的干预组成部分（即动机访谈，遵守前准备，支持小组，同伴心态和患者导航），每种都旨在解决特定的艾滋病毒护理和艺术倡议。这些组成部分在经验文献中是良好的，在初步研究中，在效率方面被发现可接受，可行和有希望。研究目的是：1）使用高效的实验设计，确定5个成分中的哪些有意义地有助于改善病毒抑制作用，以及在HIV初级保健中的艺术依从性和参与度的次要结果； 2）确定组件有效性的介体和主持人； 3）使用数学建模方法，从高效组件中构建最具成本效益，有效的干预软件包。将使用在社区环境和同行招聘中使用有针对性的采样的靶向抽样来招募非裔美国人和拉丁裔PLHA的异质样本（相对于年龄，使用物质和性少数群体状况）（n = 512）。这项高度创新和重要的研究涉及高优先研究领域（NIH NOT-OD-15-137），将为全国最脆弱的PLHA提供艾滋病毒护理的持续干预，对成本效益进行了优化，并且具有出色水平的效率，效率和可扩展性。