A sequential, adaptive model of differentiated service delivery to reach persons living with HIV who are lost-to-follow-up or who have detectable viral load

摘要 虽然艾滋病毒没有有效的治愈方法，但服用被称为抗逆转录病毒疗法(ART)的艾滋病毒药物可以减少 艾滋病毒携带者血液中艾滋病毒的数量几乎完全抑制了病毒复制和 无法检测到的病毒载量。在南非，绝大多数抗逆转录病毒药物是通过诊所分配的。新冠肺炎 大流行表明，卫生保健服务中断如何影响个人获得保健的机会。然而， 医疗保健提供的新方法使提供者能够继续满足患者的需求 在整个大流行期间。特别是在艾滋病毒护理方面，抗逆转录病毒治疗的送货上门有可能既增加 覆盖农村社区分散的抗逆转录病毒治疗，与以诊所为基础的抗逆转录病毒治疗相比，具有成本效益 艺术再来一次。在试点的交付健康研究中，我们证明了上门接生和监测抗逆转录病毒治疗， 包括客户服务费，与基于诊所的标准服务相比，提高了病毒抑制率。 此外，将抗逆转录病毒药物送货上门可能会减少携带私人物品往返诊所的人数。 车辆和公共交通，减少总体排放，并对环境产生积极影响 健康。拟议的多样性补编的目标是比较成本、成本效益、环境 两种不同ART再补给机制对病毒抑制的影响和新冠肺炎服务中断 夸祖鲁-纳塔尔，南非。该项目将利用2020年进行的一项试点研究的数据，该研究名为 研究，告知正在进行的可扩展干预措施的序贯多分配随机对照试验 在南非提供抗逆转录病毒治疗(SMART)，由该大学的Ruanne Barnabas博士共同领导 西雅图华盛顿的阿拉斯泰尔·范·希尔登博士和南非人文科学研究理事会的阿拉斯泰尔·范·希尔登博士。

ABSTRACT While there is no effective cure for HIV, taking HIV medicine called antiretroviral therapy (ART) can reduce the amount of HIV in the blood of people with HIV to almost complete suppression of viral replication and undetectable viral load. In South Africa, the vast majority of ART is dispensed through clinics. The COVID-19 pandemic demonstrated how disruptions to health care services can impact individuals' access to care. However, novel approaches to health care delivery have allowed providers to continue to meet the needs of their patients throughout the pandemic. Specifically for HIV care, home delivery of ART has the potential to both increase coverage for decentralized ART delivery in rural communities and be cost-effective in comparison to clinic-based ART refills. In the pilot Deliver Health Study, we demonstrated that home delivery and monitoring of ART, including a client fee for service, increased viral suppression compared to standard clinic-based services. Furthermore, home delivery of ART would likely reduce the number of people commuting to clinics with personal vehicles and public transportation, decrease overall emissions, and have a positive impact on environmental health. The goal of the proposed Diversity Supplement is to compare the cost, cost-effectiveness, environmental impact, and COVID-19 service disruptions of two different ART resupply mechanisms on viral suppression in KwaZulu-Natal, South Africa. This project will utilize data from a pilot study conducted in 2020, the Deliver Health Study, to inform the ongoing sequential multiple assignment randomized controlled trial of scalable interventions for antiretroviral therapy delivery (SMART ART) in South Africa co-led by Dr. Ruanne Barnabas at the University of Washington in Seattle and Dr. Alastair van Heerden at the Human Sciences Research Council in South Africa.