Structured Peer-delivered ART and Reentry Community Strategy (SPARCS) to overcome barriers to HIV care continuity during community reentry from incarceration in South Africa

结构化的同伴提供的 ART 和重返社区策略 (SPARCS)，以克服南非监狱出狱重返社区期间艾滋病毒护理连续性的障碍

• 批准号: 10700511
• 负责人: CHRISTOPHER J HOFFMANN
• 金额: $ 62.85万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700511
• 关键词: Address; Adjusted Life Years; Adopted; Adoption; Adult; Age; Behavioral; Caring; Cause of Death; Clinic; Collaborations; Communities; Continuity of Patient Care; Educational Curriculum; Effectiveness; Elements; Environment; Equilibrium; Failure; Future; General Population; Goals; Government; Group Structure; HIV; Health; Health system; Hybrids; Imprisonment; Individual; Intervention; Intervention Studies; Interview; Knowledge; Life; Maintenance; Manuals; Measures; Methods; Modification; National Institute of Mental Health; Outcome; Output; Participant; Persons; Pilot Projects; Policy Maker; Population; Prevalence; Problem Solving; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Resources; Role; Sampling; Schedule; Self Efficacy; Services; Social support; South Africa; South African; Structure; Techniques; Testing; Treatment Failure; United States National Institutes of Health; Viral Load result; Work; age group; antiretroviral therapy; community clinic; community reentry; comparative cost effectiveness; cost; cost comparison; cost effectiveness; design; disparity reduction; effectiveness evaluation; effectiveness outcome; effectiveness testing; effectiveness/implementation study; epidemic response; financial literacy; high risk; implementation cost; implementation determinants; implementation fidelity; implementation strategy; improved; improved outcome; interest; member; peer; pilot test; primary outcome; scale up; sex; skills; societal costs; statistics; substance use; treatment arm; treatment as usual; trial design; trial enrollment; usual care arm

PROJECT SUMMARY HIV remains the leading cause of death among adults in South Africa despite the availability of antiretroviral therapy (ART) due to failure to initiate ART and failure to remain on ART. Gaps in HIV care are especially prominent among key populations at high risk for both HIV and reduced use of HIV services. One population with an HIV prevalence double the age and sex-matched general population (23%) and with low engagement in HIV care is individuals recently released from incarceration. During incarceration >90% initiate ART; following reentry into the community only 34% remain in care. The transition from the controlled carceral environment and its restricted autonomy to life in the community requires reestablishing planning skills, self- efficacy, and social support and overcoming bureaucratic barriers to accessing community clinics. We have demonstrated that an intervention that circumvents clinic barriers by directly providing ART and builds behavioral skills through peer-facilitator led group sessions improves care continuity following release from incarceration. In a pilot study of this intervention supported by NIMH, termed SPARCS, among 176 participants, 36% of those in the care as usual compared to 61% of those in the intervention arm were in-care 6 months after corrections release. These results raise important questions regarding possibility of programmatic scale-up. Scale-up requires achieving a balance between effectiveness, feasibility, and cost. Notably, the tension between effectiveness and feasibility may require reducing overall effectiveness – such as by eliminating a component of SPARCS – to increase feasibility. To explore each of these questions, we are proposing a hybrid type I effectiveness-implementation study structed with the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). First, we are proposing a 2x2 factorial design to maximize power of a randomized controlled trial of the Full-SPARCS intervention and the two distinct components termed “ART-SPARCS” and “Group-SPARCS” and usual care, to test for a difference in viral load suppression 6 months from correctional facility release. Second, we propose characterize implementation in terms of reach, adoption or adoption potential, acceptability, and fidelity. Finally, will use findings from the RCT to inform costing and cost-effectiveness to inform policy makers regarding cost of SPARCS and components and cost-effectiveness of each component and the full SPARCS to inform implementation cost and potential long-term sustainability or maintenance. This project has the potential to generate considerable new knowledge on interventions that can improve care continuity for this population and key findings for potential scale-up relevant to policy makers. This proposed study has the potential to generate actionable knowledge to improve outcomes for community reentrants and contribute to overall goals of HIV epidemic control.

项目总结 尽管有抗逆转录病毒药物可用，艾滋病毒仍是南非成年人死亡的主要原因 治疗(ART)由于未能启动ART和未能坚持ART。艾滋病毒护理方面的差距尤其突出 在艾滋病毒高危人群和艾滋病毒服务使用减少的关键人群中尤为突出。一个人口 艾滋病毒流行率是年龄和性别匹配的普通人群(23%)的两倍，而且参与度低 在艾滋病毒护理中的是最近从监禁中释放的个人。在监禁期间，90%的人开始抗逆转录病毒治疗； 在重新进入社区后，只有34%的人仍在接受护理。从受控监禁的过渡 环境及其对社区生活的限制自治需要重新建立规划技能，自我 效率、社会支持和克服获得社区诊所的官僚障碍。我们有 展示了一种通过直接提供ART和建立 通过同伴辅导员领导的小组会议提高行为技能，改善出院后护理的连续性 监禁。在一项由NIMH支持的称为SPARCS的干预的试点研究中，176人 参与者中，36%的人在照常护理，而在干预组中有61%的人在护理中 更正发布后6个月。这些结果提出了关于以下可能性的重要问题 程序性纵向扩展。扩大规模需要在有效性、可行性和成本之间取得平衡。 值得注意的是，有效性和可行性之间的紧张关系可能需要降低整体有效性--例如 通过取消SPARCS的一个组件-以增加可行性。为了探索这些问题中的每一个，我们 提出了以RE-AIM框架(REACH， 有效性、采用、实施、维护)。首先，我们提出了一种2x2析因设计来 完全SPARCS干预和两种截然不同的随机对照试验的最大功率 被称为“ART-SPARCS”和“GROUP-SPARCS”的组件和常规护理，以测试病毒载量的差异 惩教所释放后6个月的禁闭时间。其次，我们提出了以下特征实现 覆盖范围、收养或收养潜力、可接受性和忠诚度的条款。最后，将使用RCT的结果 告知成本计算和成本效益，使决策者了解SPARCS和组件的成本 每个组成部分和完整的SPARCS的成本效益，以告知实施成本和潜力 长期可持续性或维持性。这个项目有可能产生相当大的新的 关于可以改善这一人群护理连续性的干预措施的知识，以及潜在的关键发现 与政策制定者相关的扩大规模。这项拟议的研究有可能产生可操作的知识，以 改善重新进入社区的人的结果，并为艾滋病毒流行控制的总体目标作出贡献。