Strengthening the Safety Net: Testing a Novel Data-to-Suppression (D2S) Intervention Strategy in the Ryan White HIV/AIDS Program

加强安全网：在 Ryan White HIV/AIDS 项目中测试新型数据抑制 (D2S) 干预策略

• 批准号: 10326932
• 负责人: Mary Kathryn Irvine
• 金额: $ 66.32万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10326932
• 关键词: AIDS/HIV problem; Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Anti-Retroviral Agents; Automobile Driving; Behavioral; COVID-19; COVID-19 pandemic; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Cities; Client; Clinical; Communication; Communities; Continuity of Patient Care; County; Data; Data Collection; Data Linkages; Diagnosis; Enrollment; Epidemic; Evidence based intervention; Factor Analysis; Focus Groups; Funding; Future; Goals; Government; HIV; HIV Infections; Health; Health system; Housing; Hybrids; Income; Intervention; Interview; Latinx; Left; Light; Link; Low income; Maintenance; Measures; Medicaid; Medical; Methods; Modeling; Modification; Monitor; Neighborhoods; New York City; Outcome; Participant; Patients; Persons; Positioning Attribute; Poverty; Provider; Psychosocial Influences; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Resources; Route; Service setting; Services; Shapes; Site; Structure; Testing; Time; Translations; Triage; Uninsured; United States Health Resources and Services Administration; Viral; antiretroviral therapy; barrier to care; base; behavioral health; care coordination; coronavirus disease; data sharing; design; effectiveness evaluation; evidence base; experimental study; follow-up; health disparity; hybrid type 1 trial; implementation measures; implementation outcomes; implementation research; implementation science; improved; intervention effect; meetings; multiple datasets; novel; outreach; preference; programs; psychosocial; research to practice; response; safety net; scale up; service delivery; service programs; service providers; social; stem; success; surveillance data; telehealth; therapy adherence; treatment arm; trial design; uptake

Abstract The Ryan White HIV/AIDS Program (RWHAP) for low-income people with HIV (PWH) is a key resource for reducing HIV health disparities and scaling up evidence-based interventions. As RWHAP serves >50% of US PWH, RWHAP outcomes are vital to achieving “getting to zero”/ Ending the HIV Epidemic (EHE) Plan targets. As a grantee for RWHAP Part A (RWPA) funding distributed to the counties/cities severely affected by HIV, New York City (NYC) conducts regular HIV care continuum monitoring citywide and in its RWPA programs, which offer support services to reduce social and behavioral barriers to care/treatment. Local data consistently show lower viral suppression (VS) among RWPA clients in HIV care than among non-RWPA PWH in HIV care. Relative to NYC HIV cases overall, NYC RWPA clients (~14,000 per year) over-represent Black and Latinx PWH and high-poverty neighborhoods. To address local outcome disparities and to fill gaps left by data-to-care (D2C) strategies and research focused on medical care (re-)linkage, we propose to implement and rigorously evaluate the effectiveness of a novel ‘data-to-suppression’ (D2S) intervention among ~1,300 RWPA clients in HIV care but unsuppressed. Surveillance-based reports on unsuppressed clients plus D2S capacity-building assistance will guide RWPA providers in targeting and delivering evidence-informed strategies to improve VS. Our proposed aims are to: 1) Measure D2S intervention effects on timely VS and time to VS, in a stepped- wedge hybrid Type 1 trial; 2) Identify modifiable determinants of D2S response, by comparing characteristics of D2S-exposed clients who do and do not achieve VS, to recognize opportunities to tailor and strengthen the intervention; 3) Assess D2S acceptability and participant preferences and priorities for its implementation, in eight (client and provider) focus groups and in a discrete choice experiment (DCE) with RWPA staff (n=200). This proposal answers the call in PAR-20-036 for research to deepen understanding of the broader context of VS, by leveraging extensive/multiple datasets and resources and applying implementation science methods to test an intervention to improve service delivery and ultimately achieve VS. The study is also aligned with the National HIV/AIDS Strategy goal to reduce health disparities – in this case, a VS gap between RWPA clients in care and other PWH in care in the same jurisdiction. The proposed study’s hybrid, Type 1 trial design supports rapid dissemination and uptake beyond NYC, should the intervention prove effective. Through the D2S trial, analysis of factors driving D2S response, and primary data collection in NYC RWPA support- service settings, the project seeks to clarify future intervention directions for low-income, Black and Latinx PWH, whose care continuum advances are vital for meeting 90-90-90, “getting to zero” and EHE Plan goals. The project’s potential impact is heightened in the time of COVID-19, given disproportionate burden of COVID- 19 and related restrictions in the communities RWPA serves, and new obstacles to continuity of care/treatment and to maintaining close communication between medical and support-service providers about clients’ needs.

抽象的 Ryan White 艾滋病毒/艾滋病计划 (RWHAP) 是针对低收入艾滋病毒感染者 (PWH) 的一项重要资源 减少艾滋病毒健康差距并扩大循证干预措施。由于 RWHAP 服务于美国超过 50% 的地区 PWH、RWHAP 结果对于实现“实现零”/结束艾滋病毒流行 (EHE) 计划目标至关重要。 作为 RWHAP A 部分 (RWPA) 资金的受赠者，该资金分配给受艾滋病毒严重影响的县/市， 纽约市 (NYC) 在全市范围内及其 RWPA 计划中定期开展艾滋病毒护理连续监测， 提供支持服务，以减少护理/治疗的社会和行为障碍。本地数据一致 研究表明，接受艾滋病毒护理的 RWPA 客户中的病毒抑制 (VS) 低于接受艾滋病毒护理的非 RWPA 感染者的病毒抑制 (VS)。 相对于纽约市艾滋病毒病例总数，纽约市 RWPA 客户（每年约 14,000 名）黑人和拉丁裔人数过多 PWH 和高度贫困社区。解决当地结果差异并填补数据护理留下的空白 （D2C）战略和研究重点关注医疗（再）联动，我们建议实施并严格 在约 1,300 名 RWPA 客户中评估新型“数据抑制”（D2S）干预措施的有效性 艾滋病毒护理但未受到抑制。基于监控的未受抑制客户报告以及 D2S 能力建设 援助将指导 RWPA 提供者确定目标并提供基于证据的策略来改善 VS。 我们提出的目标是： 1) 逐步测量 D2S 干预对及时 VS 和 VS 时间的影响 楔形混合1型试验； 2) 通过比较 D2S 响应的特征来确定可修改的决定因素 接触过 D2S 且未实现 VS 的客户，认识到定制和加强 D2S 的机会 干涉; 3) 评估 D2S 的可接受性以及参与者的偏好和实施的优先级， 八个（客户和提供商）焦点小组以及与 RWPA 工作人员 (n=200) 进行的离散选择实验 (DCE)。 该提案响应了 PAR-20-036 中的研究号召，以加深对更广泛背景的理解 VS，通过利用广泛/多个数据集和资源并应用实施科学 测试干预措施以改善服务提供并最终实现 VS 的方法。该研究还 与国家艾滋病毒/艾滋病战略目标保持一致，以减少健康差距——在这种情况下， RWPA 接受护理的客户和同一司法管辖区接受护理的其他 PWH。拟议研究的混合型 1 型试验 如果干预措施被证明是有效的，设计支持在纽约市以外的地区快速传播和吸收。通过 D2S 试验、驱动 D2S 响应的因素分析以及纽约市 RWPA 支持中的主要数据收集 - 服务设置，该项目旨在明确低收入、黑人和拉丁裔的未来干预方向 PWH 的护理连续性进步对于实现 90-90-90、“实现零”和 EHE 计划目标至关重要。 鉴于 COVID-19 造成的不成比例的负担，该项目的潜在影响在 COVID-19 时期更加突出。 19 和 RWPA 服务社区的相关限制，以及护理/治疗连续性的新障碍 并就客户的需求保持医疗和支持服务提供商之间的密切沟通。