Promoting Sustained Viral Suppression Through Implementation of an Adapted Evidence-Informed Low-Barrier Care Model in a System of HIV Primary Care Clinics

通过在艾滋病毒初级保健诊所系统中实施适应性强的循证低门槛护理模式，促进持续的病毒抑制

• 批准号: 10675620
• 负责人: Nanette Dior Benbow
• 金额: $ 79.14万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-02 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675620
• 关键词: Acute; Address; Adoption; Area; Caring; Case Management; Centers for Population Health; Chicago; Clinic; Complex; Continuity of Patient Care; County; Data; Diagnosis; Diffuse; Discrimination; Effectiveness; Eligibility Determination; Epidemic; Face; Funding; Goals; HIV; Health Services Accessibility; Home; Homelessness; Illinois; Incentives; Individual; Insurance; Lead; Learning; Location; Maps; Mental Health; Methods; Modeling; NIH Office of AIDS Research; Outcome; Persons; Phase; Population; Poverty; Preparation; Primary Care; Process; Process Assessment; Protocols documentation; Public Health; Ramp; Screening procedure; Services; Site; Substance abuse problem; System; Time; Training; United States; Viral; Visit; Walking; Work; arm; budget impact; care coordination; care delivery; care providers; contextual factors; cooking; cost; data enclave; design; disparity reduction; epidemic preparedness; evidence base; experience; follow-up; implementation context; implementation cost; implementation evaluation; implementation fidelity; implementation outcomes; implementation protocol; implementation research; implementation science; implementation strategy; improved; innovation; interest; outreach; pragmatic trial; primary care clinic; retention rate; service delivery; service engagement; social factors; social stigma; structural determinants; substance use; time use; treatment disparity; trial design; viral transmission

PROJECT SUMMARY/ABSTRACT The goal to end the HIV epidemic (EHE) in the United States cannot be achieved if people with HIV (PWH) do not achieve sustained viral suppression (VS). However, more than half of PWH in the US do not receive regular HIV care, due largely to social and structural factors like stigma and discrimination, poverty, and care complexity, as well as conditions like mental health and substance abuse. Additional approaches to care delivery, especially for PWH experiencing compounding barriers, are needed to close the gap in sustained care and VS. Low-barrier care (LBC) is a package of implementation and care engagement strategies developed specifically to address barriers experienced by PWH with complex needs and has been shown to significantly improve VS among this population. The original model of standalone LBC clinics, however, may have challenges in scalability due to feasibility and limited reach to PWH within large areas. In contrast, adapting LBC strategies for integration into existing HIV primary care sites has the potential to facilitate greater use of this promising model of HIV care while also engaging more PWH with unaddressed needs. The overarching goal of this proposal is to evaluate the implementation and effectiveness of adapted LBC strategies in a system of 12 HIV population-centered health homes (PCHHs) funded by the Chicago Department of Public Health (CDPH) using a pragmatic trial design. Guided by the EPIS framework, we will achieve this goal through three specific aims: (1) Facilitate adoption, adaptation, and implementation of LBC strategies by PCHHs using a learning collaborative. Learning collaboratives are widely used, evidence-based implementation strategies. Following best practices, a lead facilitator and subject matter experts will help PCHHs explore and prepare protocols for implementation of LBC strategies while trained practice coaches will provide technical assistance around implementation at each site. CDPH has strong interest in integrating LBC strategies into PCHHs and will both mandate PCHH participation in the learning collaborative and encourage LBC implementation through additional funding. We will assess the process of adoption and implementation of LBC strategies using mixed methods. (2) Evaluate site-specific and system-wide effectiveness of integrated LBC strategies at improving sustained care and VS. Using a single-arm, pre–post trial design, we will assess if rates of retention in care and VS improve in the two years following ramp-up of LBC strategies. We will also examine contextual factors and implementation fidelity using mixed methods to explain variability in outcomes across PCHHs. (3) Assess implementation cost and sustainment of LBC strategies among PCHHs. We will examine implementation costs over time and plans for sustainment using mixed methods. Our proposal directly responds to RFA-AI-21-024 and is consistent with the NIH Office of AIDS Research’s high priority of implementation science to improve HIV service delivery and reduce disparities in treatment. Results from this study will facilitate the use of LBC strategies in new settings to reach PWH with complex needs.

项目总结/摘要 如果艾滋病毒感染者（PWH） 不能达到持续的病毒抑制（VS）。然而，超过一半的PWH在美国没有收到 定期的艾滋病毒护理，主要是由于社会和结构性因素，如耻辱和歧视，贫困和护理 复杂性，以及心理健康和药物滥用等情况。提供护理的其他方法， 特别是对于遇到复合障碍的PWH，需要缩小持续护理和VS的差距。 低障碍护理（LBC）是一套实施和护理参与战略， 特别是解决威尔斯亲王医院遇到的障碍，有复杂的需要，并已被证明显着 改善这一人群的VS。然而，独立LBC诊所的原始模式可能存在挑战 由于可行性和在大面积范围内接触到威尔斯亲王医院的有限性，相反，适应LBC战略 整合到现有的艾滋病毒初级保健网站有可能促进更多地使用这一有前途的 同时也让更多有需要的威尔斯亲王医院参与。这个项目的首要目标是 一项建议是评估在一个由12名艾滋病毒感染者组成的系统中适应性LBC战略的实施情况和有效性 由芝加哥公共卫生部（CDPH）资助的以人口为中心的健康之家（PCHH）， 一个务实的试验设计在EPIS框架的指导下，我们将通过三个具体目标实现这一目标： (1)促进PCHH采用、调整和实施LBC战略， 协作。学习协作是广泛使用的循证实施战略。以下 最佳实践，一个主要的促进者和主题专家将帮助PCHH探索和准备协议， 实施LBC战略，而训练有素的实践教练将提供技术援助， 在每个站点执行。CDPH对将LBC策略整合到PCHH中有浓厚的兴趣， 授权PCHH参与学习协作，并通过其他方式鼓励LBC实施 经费我们将使用混合方法评估采用和实施LBC战略的过程。 (2)评估综合性LBC战略在改善环境方面的针对具体地点和全系统的有效性 持续护理和VS。使用单组、前后试验设计，我们将评估护理保留率 和VS在LBC战略实施后的两年内有所改善。我们还将研究背景因素 以及使用混合方法来解释PCHH之间结果的可变性的实现保真度。 (3)评估在PCHH中实施LBC战略的成本和可持续性。我们将研究 随着时间的推移，执行费用和使用混合方法的维持计划。 我们的提案直接响应RFA-AI-21-024，并与NIH艾滋病研究办公室的 高度优先执行科学，以改善艾滋病毒服务的提供和减少治疗方面的差距。 这项研究的结果将有助于在新的环境中使用LBC策略，以达到有复杂需求的PWH。