FREEDOM-HIV

自由-艾滋病毒

• 批准号: 10674343
• 负责人: MONICA L. BASKIN
• 金额: $ 37.13万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10674343
• 关键词: AIDS/HIV problem; Address; Adult; Affect; Age; Behavior Therapy; Black American; Black Populations; Black race; Blood Pressure; CD4 Positive T Lymphocytes; Cardiometabolic Disease; Caring; Cell Count; Chronic Disease; Clinical; Communication; Communities; Consolidated Framework for Implementation Research; Deep South; Diabetes Mellitus; Discrimination; Economics; Education; Enrollment; Food; Glycosylated hemoglobin A; Goals; HIV; HIV Seronegativity; HIV diagnosis; Health; Health Food; Health Services Accessibility; Health system; Healthcare Systems; Hemoglobin; Household; Hypoglycemia; Individual; Inflammation; Insulin; Insulin Resistance; Intervention; Low income; Mental Health; Metformin; Methods; Mission; National Institute on Minority Health and Health Disparities; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Parents; Participant; Patient Care Team; Persons; Pharmacologic Substance; Plant Roots; Politics; Population; Poverty; Quality of life; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Research; Social Conditions; Stress; Structural Racism; Sulfonylurea Compounds; Transportation; Treatment outcome; Viral Load result; Weight; Woman; Work; antiretroviral therapy; cardiometabolism; contextual factors; design; diabetes control; diabetes education; diabetes management; dietary; digital health; disparity reduction; effectiveness evaluation; experience; experimental study; food insecurity; glucose monitor; glycemic control; health care availability; health care economics; health disparity; health equity; health equity promotion; implementation framework; implementation intervention; implementation outcomes; implementation process; improved; individual patient; industry partner; men; mortality risk; multiphase optimization strategy; parent project; pilot test; primary outcome; programs; racial health disparity; recruit; remote delivery; remote monitoring; remote patient monitoring; response; social health determinants; social vulnerability; treatment adherence; trend

Advances in treatment and care have transitioned HIV from a fatal to a chronic disease. Primary health concerns of this population have accordingly transitioned to co-occurring chronic diseases like T2DM and their interaction with HIV treatment. The highest rates of T2DM are found in Deep South states and disproportionately burden Black Americans. Additionally, while only 13% of the U.S. population, Black Americans account for 43% of new HIV diagnoses. Like T2DM, these disparities are most pronounced in the South, where over half of new HIV diagnoses occur. Over half of the racial health disparities related to T2DM and HIV can be attributed to social determinants of health (SDoH), including reduced healthcare access, poverty, transportation barriers, and food insecurity. There is a need for effective and sustainable intervention packages that address T2DM-related outcomes and improve health equity for people living with HIV (PWH). This is critical since people on HIV treatment have poor glycemic outcomes, which can also hinder the HIV treatment adherence. The overall goal of the Food Delivery, Remote Monitoring, and Coaching-Enhanced EDucation for Optimized Diabetes Management for People Living with HIV (FREEDOM-HIV) study is to develop an optimized, multilevel, and scalable intervention to improve T2DM control in low-income Black adults with HIV and T2DM in the Deep South by targeting relevant SDoH. The FREEDOM-HIV study will enroll 80 Black adults with suboptimal SDoH through three health systems in AL and MS. A randomized factorial optimization design using a multiphase optimization strategy (MOST) will evaluate three intervention components: 1) digital health coaching, 2) food box delivery, and 3) remote patient monitoring (RPM). Thus, this project will evaluate multilevel interventions that address changes at the levels of individual (patient), interpersonal (patientcare team communication), organizational (healthcare system-delivered RPM), and community (food box delivery) to improve T2DM management among socially vulnerable Black adults with HIV and T2DM. Aim 1 will identify the combination(s) of the three intervention components that reduce HbA1c (primary outcome) at 12 months. Aim 2 will identify contextual factors that impact implementation of these different interventions using a Consolidated Framework for Implementation (CFIR) approach, and the implementation outcomes will be assessed via the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. This study will leverage multi-healthcare system and healthcare system– industry partnerships from our parent project FREEDOM to develop optimized, sustainable intervention strategies to improve T2DM outcomes in socially vulnerable Black adults living with HIV in the Deep South.

治疗和护理方面的进步已使艾滋病毒从致命疾病转变为慢性疾病。初级卫生 因此，这一人群的担忧已转变为合并发生的慢性疾病，如T2 DM及其 与艾滋病治疗的互动。2型糖尿病发病率最高的地区是深南州， 不成比例地加重了美国黑人的负担。此外，虽然只有13%的美国人口，黑人 美国人占新诊断艾滋病毒的43%。与T2 DM一样，这些差异在 南部，超过一半的新艾滋病毒诊断发生在那里。超过一半的种族健康差异与T2 DM有关 和艾滋病毒可归因于健康的社会决定因素（SDoH），包括医疗保健服务的减少， 贫困、交通障碍和粮食不安全。需要进行有效和可持续的干预 解决T2 DM相关结果并改善艾滋病毒感染者（PWH）健康公平性的一揽子计划。 这是至关重要的，因为接受艾滋病毒治疗的人血糖结果很差，这也会阻碍艾滋病毒的传播。 治疗依从性。食品配送、远程监控和指导的总体目标-增强 艾滋病病毒感染者优化糖尿病管理教育（FREEDOM-HIV）研究是为了 制定优化的、多层次的、可扩展的干预措施，以改善低收入黑人成年人的T2 DM控制 通过针对相关的SDoH，在南方腹地的艾滋病毒和2型糖尿病患者中。FREEDOM-HIV研究将招募80名 在AL和MS的三个卫生系统中，黑人成年人的SDoH不理想。 使用多阶段优化策略（MOST）的优化设计将评估三种干预措施 这些组件包括：1）数字健康指导，2）食品盒交付，以及3）远程患者监护（RPM）。因此，在本发明中， 该项目将评估针对个人（患者）层面变化的多层面干预措施， 人际（患者护理团队沟通）、组织（医疗保健系统提供的RPM）和 社区（食品盒交付），以改善社会弱势的黑人艾滋病毒感染者中的T2 DM管理 和T2 DM。目标1将确定降低HbA 1c的三种干预成分的组合 （主要结局）12个月时。目标2将确定影响这些目标执行的背景因素 采用综合执行框架方法的不同干预措施， 实施结果将通过覆盖范围、有效性、采用、实施和 RE-AIM框架。这项研究将利用多个医疗保健系统和医疗保健系统- 我们的母项目FREEDOM的行业合作伙伴关系，以开发优化的，可持续的干预措施 改善南方腹地艾滋病毒感染者中社会弱势黑人成年人T2 DM结局的战略。