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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：
9888341
负责人：
LINDA M COLLINS
金额：
$ 76.25万
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 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9888341
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 Participant Patients Performance Persons Population Preparation Prevention Primary Health Care Public Health Randomized Randomized Controlled Trials Recording of previous events Research Research Methodology Research Priority Resources Risk Factors Sampling Science Scientist Self Determination Services Signal Transduction Structure 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 multiphase optimization strategy peer primary outcome public health relevance racial and ethnic racial and ethnic disparities recruit secondary outcome sexual minority social social cognitive theory social stigma theories therapy adherence transmission process treatment services

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.