A type 2 hybrid effectiveness-implementation trial to evaluate a population health combination intervention to meet HIV testing, linkage, and viral suppression goals in coastal Alabama

一项 2 型混合有效性实施试验，旨在评估人口健康组合干预措施，以实现阿拉巴马州沿海地区的 HIV 检测、关联和病毒抑制目标

• 批准号: 10653984
• 负责人: Lynn T Matthews
• 金额: $ 90.03万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10653984
• 关键词: Acquired Immunodeficiency Syndrome; Administrator; Adult; Affect; Alabama; Area; Attitude; Big Data; Caring; Centers for Disease Control and Prevention (U.S.); Client; Clinic; Clinical; Clinical effectiveness; Collaborations; Communities; Consolidated Framework for Implementation Research; County; Data; Data Set; Deep South; Diagnosis; Diagnostic; Epidemic; Evaluation; Evidence based intervention; Federally Qualified Health Center; Funding; Future; Geography; Goals; HIV; HIV diagnosis; Health; Health Service Area; Health system; Human immunodeficiency virus test; Incidence; Individual; Inequity; Intervention; Interview; Learning; Link; Maintenance; Maps; Mission; Newly Diagnosed; Outcome; Persons; Population; Positioning Attribute; Poverty; Prevalence; Process; Provider; Public Health; Qualitative Methods; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Personnel; Rural; Surveys; System; Techniques; Testing; Time; United States; United States Dept. of Health and Human Services; Universities; Viral; Work; antiretroviral therapy; care systems; community clinic; concept mapping; effectiveness outcome; effectiveness/implementation study; effectiveness/implementation trial; experience; formative assessment; implementation evaluation; implementation outcomes; implementation strategy; implementation trial; implementation/effectiveness; improved; innovation; meetings; novel; outreach; population health; prevention service; programs; racial disparity; rural counties; social stigma; surveillance data; tool

Abstract This proposal describes a 5-year research plan to adapt and evaluate implementation of three evidence-based interventions to achieve the goals of Ending the HIV Epidemic (EHE) in Alabama (AL). This combination intervention will (1) use novel big data approaches to inform precision public health efforts to increase testing in priority populations, (2) decrease time to linkage to care, and (3) decrease time to viral suppression (VS) among persons newly diagnosed with HIV in AL, a priority state in the national EHE Initiative. The proposal leverages a dynamic and innovative collaboration of experienced investigators from the University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR) and the HIV Divisions of the state health department in AL (ADPH) and the Mobile County Health Department (MCHD). The MCHD serves six predominantly rural counties in the southwestern region of AL with low testing coverage, high incidence, and suboptimal times to linkage and VS for newly diagnosed cases of HIV. We propose a type 2 hybrid implementation-effectiveness study guided by the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks to adapt, implement, and evaluate three Centers for Disease Control (CDC) evidence-based interventions: (1) a data-driven approach to direct Community-based HIV testing in areas with low testing coverage, (2) Project Connect, to expedite linkage at time of diagnosis and (3) a Rapid ART start program at MCHD community clinics in Alabama (“COAST-AL”). In Aim 1, we will use qualitative methods to adapt COAST-AL combination intervention to the local context. In Aim 2, we will deploy the adapted intervention across MCHD services areas over 36 months. Our primary effectiveness outcome is days to VS after HIV diagnosis using state-level surveillance data from ADPH. Our primary implementation outcome is proportion of zip code tabulation areas with at least 15% of the adult population tested by 36 months compared to baseline using surveillance and commercial HIV testing data sets. We will evaluate intervention acceptability, feasibility, appropriateness from clients through in-depth interviews and with providers through surveys. In Aim 3 we will conduct interviews with key stakeholders and work collaboratively with local and state health department stakeholders to identify and prioritize implementation strategies that can be deployed to sustain COAST-AL and facilitate its implementation in other public health jurisdictions across AL and other rural EHE-prioritized states. Results of this research will lay the groundwork for a larger implementation trial that will include rigorous evaluation of implementation strategies to integrate COAST-AL into clinical and public health systems to meet EHE targets.

抽象的 该提案描述了一项为期5年的研究计划，以适应和评估三个的实施 基于证据的干预措施，以实现阿拉巴马州（AL）结束HIV流行（EHE）的目标。 这种组合干预将（1）使用新颖的大数据方法来为精确的公共卫生提供信息 努力增加优先人群的测试，（2）减少与护理联系的时间，（3）减少 是时候在AL中新诊断为艾滋病毒的人中进行病毒抑制（VS），这是优先状态 国家EHE倡议。该提案利用了经验丰富的动态和创新的合作 阿拉巴马大学伯明翰（UAB）艾滋病研究中心（CFAR）的研究人员 以及AL（ADPH）和移动县卫生的国家卫生部门的艾滋病毒师 部门（MCHD）。 MCHD在西南地区为六个主要的农村县服务 AL的测试覆盖率低，较高的事件和次优时与新的链接和vs 诊断为艾滋病毒。我们提出了一项由以 合并实施研究框架（CFIR）和覆盖范围，有效性，采用， 实施和维护（RE-AIM）框架以适应，实施和评估三个 疾病控制中心（CDC）基于证据的干预措施：（1）直接数据驱动的方法 （2）项目Connect的区域中，基于社区的艾滋病毒测试，以加快 诊断时的联系和（3）阿拉巴马州MCHD社区诊所的快速艺术开始计划 （“沿海”）。在AIM 1中，我们将使用定性方法来适应沿海的组合干预 到本地环境。在AIM 2中，我们将在MCHD服务领域部署改编的干预措施 超过36个月。我们的主要有效性结果是使用状态级别的HIV诊断后的几天VS 来自ADPH的监视数据。我们的主要实现结果是邮政编码表的比例 与基线相比，至少有15％的成人人口的区域比使用 监视和商业艾滋病毒测试数据集。我们将评估干预可接受性， 可行性，通过深入访谈的客户的适当性以及通过调查与提供者的可行性。 在AIM 3中，我们将与主要利益相关者进行访谈，并与地方和州合作 卫生部门利益相关者确定和优先级可以部署实施策略 维持沿海地区并促进其在AL和 其他粗略的优先状态。这项研究的结果将为更大的基础奠定基础 实施试验将包括对实施策略进行严格评估以整合 沿海地区进入临床和公共卫生系统，以实现EHE目标。