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.

摘要 莱恩·怀特针对低收入艾滋病毒携带者(PWH)的艾滋病毒/艾滋病方案(RWHAP)是 缩小艾滋病毒健康差距，扩大循证干预。RWHAP服务于美国50%的人口 PWH、RWHAP的成果对于实现“零增长”/结束艾滋病毒流行(EHE)计划的目标至关重要。 作为向受艾滋病毒严重影响的县/市分配RWHAP A部分(RWPA)资金的受赠人， 纽约市(NYC)在全市范围内及其RWPA计划中进行定期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 显示在接受HIV护理的RWPA客户中的病毒抑制(VS)低于在HIV护理中的非RWPA PWH客户。 相对于纽约市总体艾滋病毒病例，纽约市RWPA客户(每年约14,000人)代表黑人和拉丁裔 威尔斯亲王医院和高度贫困社区。解决地方结果差异并填补数据到护理留下的空白 (D2C)战略和研究侧重于医疗(再)联动，我们建议严格执行和 在约1,300名RWPA客户中评估一种新的“数据到抑制”(D2S)干预的有效性 艾滋病毒护理，但不受抑制。基于监控的未受抑制客户端报告以及D2S能力建设 援助将指导RWPA提供者瞄准并提供循证战略，以改善VS。 我们提出的目标是：1)测量D2S干预对VS的及时VS和时间VS的影响，在步进式的 楔形杂交1型试验；2)通过比较D2S反应的特征，确定D2S反应的可修改决定因素 有D2S风险敞口的客户，无论是否实现VS，都要认识到定制和加强 干预措施；3)评估D2S的可接受性以及参与者对其实施的偏好和优先事项，#年 八个(客户和提供者)焦点小组和与RWPA工作人员(n=200)进行的离散选择实验(DCE)。 这一建议回应了PAR-20-036中关于进行研究以加深对更广泛背景的理解的呼吁 通过利用大量/多个数据集和资源并应用实施科学 测试改善服务提供并最终实现VS的干预措施的方法。这项研究也是 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， 在CARE中的RWPA客户和在同一司法管辖区内的其他PWH。这项拟议的研究是一种杂交的1型试验 如果干预被证明是有效的，设计支持在纽约以外的地区迅速传播和吸收。穿过 D2S试验、驱动D2S响应的因素分析以及纽约市RWPA支持的主要数据收集- 在服务环境方面，该项目试图明确未来对低收入、黑人和拉丁裔的干预方向 威尔斯亲王医院的护理连续进步对于实现90-90-90、“达到零”和EHE计划目标至关重要。 考虑到CoVID的不成比例的负担，该项目的潜在影响在新冠肺炎的时候被加强了- 19和RWPA服务的社区中的相关限制，以及持续护理/治疗的新障碍 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。