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

摘要 本提案描述了一项五年研究计划，以适应和评估三项计划的实施情况 以证据为基础的干预措施，以实现结束阿拉巴马州(AL)艾滋病毒流行(EHE)的目标。 这一组合干预将(1)使用新的大数据方法向精准的公共健康提供信息 努力增加在优先人群中的检测，(2)减少与护理挂钩的时间，以及(3)减少 AL中新诊断为HIV感染者的病毒抑制时间(VS)，在 国家EHE倡议。该提案充分利用了经验丰富的 阿拉巴马大学伯明翰分校艾滋病研究中心(CFAR)的研究人员 以及州卫生部门在AL(ADPH)和莫比尔县卫生局的艾滋病毒部门 医学部(MCHD)MCHD服务于西南地区的六个以农村为主的县 检测覆盖率低、发病率高、连接时间不佳的AL和新的VS 确诊的艾滋病毒病例。我们提出了一项第二类混合实施-有效性研究，该研究由 实施研究综合框架(CFIR)和REACH、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)循证干预：(1)数据驱动的方法，以指导 在检测覆盖率较低的地区进行基于社区的艾滋病毒检测，(2)项目连接，以加快 诊断时的联系和(3)阿拉巴马州MCHD社区诊所的快速ART启动计划 (“海岸-AL”)。在目标1中，我们将使用定性方法来适应海岸-AL联合干预 与当地的环境相适应。在目标2中，我们将在母婴健康服务地区部署适应的干预措施 超过36个月。我们的主要有效结果是使用州一级的艾滋病毒诊断后几天内 来自ADPH的监测数据。我们的主要实施成果是邮政编码列表的比例 与基准相比，在36个月内测试至少15%的成年人口的地区使用 监测和商业艾滋病毒检测数据集。我们将评估干预措施的可接受性， 通过深度访谈和调查从客户那里获得的可行性、适当性。 在目标3中，我们将与主要利益相关者进行访谈，并与地方和州政府合作 卫生部门利益相关者确定可以部署的实施战略并确定其优先顺序 维持海岸线-AL并促进其在整个海岸线和其他公共卫生管辖区的实施 其他农村EHE优先考虑的州。这项研究的结果将为更大规模的 实施试验，将包括对实施战略进行严格评估，以整合 COSTAY-AL进入临床和公共卫生系统，以实现EHE目标。

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.