Adaptation, execution, and evaluation of a differentiated service delivery model for PMTCT

PMTCT 差异化服务提供模式的调整、执行和评估

• 批准号: 10390373
• 负责人: John M Humphrey
• 金额: $ 14.42万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-09 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10390373
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Africa; Applied Research; Breastfed infant; Caring; Client; Clinic; Clinical; Communicable Diseases; Complex; Data; Databases; Eastern Africa; Educational workshop; Epidemiology; Evaluation; Goals; Guidelines; HIV; Health; Horizontal Disease Transmission; Human immunodeficiency virus test; Implementation readiness; Individual; Internal Medicine; International; Kenya; Knowledge; Literature; Maternal and Child Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Mission; Modeling; Morbidity - disease rate; Mother-to-child HIV transmission; National Institute of Child Health and Human Development; Outcome; Patient Preferences; Patients; Pediatrics; Persons; Population; Positioning Attribute; Postpartum Period; Postpartum Women; Practical Robust Implementation and Sustainability Model; Pregnancy; Pregnant Women; Prevention; Prevention therapy; Provider; Reach Effectiveness Adoption Implementation and Maintenance; Research; Research Infrastructure; Research Methodology; Research Personnel; Research Priority; Research Training; Resource-limited setting; Risk; Service delivery model; Services; Shapes; Southern Africa; Time; Training; United States National Institutes of Health; Viral; Woman; Wool; World Health Organization; adverse pregnancy outcome; antenatal; antiretroviral therapy; career; career development; clinical infrastructure; contextual factors; design; disability; evidence base; experience; experimental study; follow-up; health care availability; human centered design; implementation evaluation; implementation framework; implementation outcomes; implementation research; implementation strategy; improved; improved outcome; infant outcome; male; mortality; organizational readiness; preference; programs; research and development; service delivery; skills; stakeholder perspectives; transmission process; user centered design

Project Summary/Abstract Globally, approximately 1.4 million pregnancies are impacted by HIV every year. In Eastern and Southern Africa, nearly a third of women living with HIV initiating ART during pregnancy become lost to follow-up (LTFU) and 29-42% do not maintain viral suppression in the postpartum period. Differentiated service delivery (DSD) is an evidence-based implementation strategy endorsed by the World Health Organization to improve retention and viral suppression for people living with HIV. DSD simplifies and adapts HIV services to meet the needs and preferences of clinically stable clients, allowing for intensification of service delivery to unstable clients who are most in need. However, DSD models for prevention of mother to child transmission of HIV (PMTCT) are lacking and data to guide the adaptation of DSD to PMTCT are scarce. The objective of this K23 research is to adapt, execute and evaluate a DSD model for PMTCT to enhance retention and viral suppression for this population. The central hypothesis is that retention and viral suppression are driven by a complex interplay of individual and contextual factors that affect women differently and shape their preferences for services. PMTCT programs in resource-limited settings can improve outcomes by tailoring service delivery to more accurately and efficiently meet clients’ needs and preferences using a DSD approach. The specific aims are: (1) Determine patient preferences for PMTCT services through a discrete choice experiment with pregnant and postpartum women living with HIV who are retained in care or LTFU, and use these data to identify components for the DSD model; (2) Develop a DSD model for PMTCT and build organizational readiness for implementation, using a human-centered design approach that incorporates stakeholders’ perspectives; (3) Execute a DSD model for PMTCT at one maternal and child health clinic in a resource-limited setting, and evaluate the model’s implementation using the RE-AIM/PRISM framework. This research will take place at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya and utilize the research infrastructure of the East Africa International Epidemiology Databases to Evaluate AIDS (EA-IeDEA) Consortium. In addition to developing new knowledge, this K23 award will support the career development and training of the PI, Dr. John Humphrey, so that he can achieve his career goal. His career goal is to become an independent investigator with expertise in implementation strategies to improve HIV outcomes in resource-limited settings, with a specific focus on PMTCT. His training aims are: (1) Designing optimized implementation strategies using discrete choice methodology and integrating data generated through multi-methods research; (2) Executing and evaluating implementation strategies using implementation frameworks. This K23 will yield an evidence- based DSD model for PMTCT, filling a major gap in the guidelines and literature for this population. This K23 will also position Dr. Humphrey to develop an R01 to conduct a large-scale trial of a DSD model for PMTCT in the EA-IeDEA network as an independent investigator.

项目摘要/摘要 在全球范围内，每年大约有140万例妊娠受HIV影响。在东部和南部 非洲，几乎三分之一的妇女在怀孕期间丧生的艾滋病毒发起艺术的妇女因随访而丧生（LTFU） 在产后期间，29-42％不能保持病毒抑制。差异化服务交付（DSD）是 世界卫生组织认可的基于证据的实施策略，以改善保留率 和病毒抑制艾滋病毒感染者。 DSD简化和调整艾滋病毒服务以满足需求 以及临床稳定客户的偏好，允许将服务提供给不稳定客户的服务交付 最需要。但是，预防母亲传播HIV（PMTCT）的DSD模型为 缺乏指导DSD对PMTCT适应的数据很少。这项K23研究的目的是 适应，执行和评估PMTCT的DSD模型，以增强保留率和病毒抑制 人口。中心假设是保留和病毒抑制是由复杂的相互作用驱动的 对女性有不同影响并影响其服务偏好的个人和上下文因素。 资源有限设置中的PMTCT程序可以通过调整服务交付来改善结果 使用DSD方法准确有效地满足客户的需求和偏好。具体目的是： （1）通过对怀孕和 保留在护理或LTFU的艾滋病毒的产后妇女，并使用这些数据来识别 DSD模型的组件； （2）开发用于PMTCT的DSD模型并建立组织准备 实施，采用以人为本的设计方法，结合了利益相关者的观点； （3） 在资源有限的环境中，在一个母校和儿童健康诊所执行PMTCT的DSD模型， 使用RE-AIM/PRISM框架评估模型的实现。这项研究将在 在肯尼亚提供医疗保健（AMPATH）的学术模型，并利用 东非国际流行病学数据库评估艾滋病（EA-EIDEEA）财团。此外 开发新知识，该K23奖将支持PI的职业发展和培训，John博士 汉弗莱，以便他可以实现自己的职业目标。他的职业目标是成为独立调查员 具有实施策略方面的专业知识，以改善资源有限设置中的HIV结果，并具有 对PMTCT的具体关注。他的培训目的是：（1）使用 离散选择方法和通过多方法研究产生的数据集成； （2）执行 并使用实施框架评估实施策略。该K23将产生证据 - 基于PMTCT的DSD模型，填补了该人群的指南和文献的主要空白。这个K23 还将定位Humphrey博士开发R01，以对PMTCT进行大规模试验 EA-IDEEA网络是独立研究者。