Improving Prevention Systems to Reduce Disparities for High Priority Populations.

改进预防系统，减少高优先人群的差异。

• 批准号: 10088339
• 负责人: Sarit A Golub
• 金额: $ 60.16万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10088339
• 关键词: AIDS prevention; Address; Appointment; Caring; Centers for Disease Control and Prevention (U.S.); Cluster randomized trial; Collection; Contact Tracing; Continuity of Patient Care; Cost Allocation; Country; Data; Decision Making; Development; Education; Effectiveness; Epidemic; Evaluation; Evidence based practice; Exposure to; Goals; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; Health; Health Services; High Prevalence; Human immunodeficiency virus test; Individual; Infection; Insurance; International; Intervention; Knowledge; Lesbian Gay Bisexual Transgender; Medical; Mental Health; Methods; Modeling; Neighborhoods; New York City; Newly Diagnosed; Notification; Oral; Outcome; Patients; Pharmaceutical Preparations; Population; Prevention; Process; Protocols documentation; Provider; Public Health; Records; Regulation; Research; Research Project Grants; Resources; Risk; Service delivery model; Services; Sexual Health; Sexually Transmitted Diseases; System; Testing; Time; Translating; Treatment Efficacy; Underserved Population; United States; United States National Institutes of Health; acceptability and feasibility; base; budget impact; care seeking; care systems; cost effectiveness; cost estimate; cost outcomes; design; disparity reduction; economic evaluation; economic outcome; effectiveness testing; high risk; high risk population; implementation cost; implementation science; improved; incremental cost-effectiveness; innovation; mortality; pre-exposure prophylaxis; primary outcome; programs; randomized trial; secondary outcome; service programs; sexual health intervention; treatment as prevention; uptake

7. PROJECT SUMMARY This project collaborates with the New York City Department of Health and Mental Hygiene (NYC DOHMH) to develop and test a field-based comprehensive sexual health intervention for HIV-exposed contacts notified by its Partner Services (i.e., HIV contact tracing) program. Individuals reached by PS programs are highest priority for linkage to HIV prevention/care services: 10-20% are newly diagnosed with HIV as a result of PS notification and the remainder are eligible and high priority for PrEP. Because they seek out highest-risk individuals in the field, PS programs have the potential to significantly reduce existing disparities in PrEP uptake and timely HIV care initiation by reaching populations that are currently under-engaged by traditional PrEP or HIV testing programs. The new Partner Services-Sexual Health (PS-SH) intervention offers a comprehensive sexual health package that includes HIV testing, STI testing, ARV/PrEP education and immediate medication start to all individuals receiving contact notification (i.e., being notified of a recent exposure to HIV). NYCDOHMH is collaborating on this research project to enable a scientifically rigorous test of the intervention’s efficacy and produce the highest quality data on implementation dynamics, cost-effectiveness, and affordability to inform dissemination and adaptation of the intervention, should it prove effective. The specific aims are to: (1) Pilot and refine a field-based comprehensive sexual health intervention delivered through the NYC DOHMH Partner Services Program. Under this aim, we will pilot the intervention in five highest prevalence NYC neighborhoods for 6-months (n = ~60), examine feasibility and acceptability, and refine the intervention process and protocols for the trial to test effectiveness at scale. (2) Examine the effectiveness of the Partner Services-Sexual Health (PS-SH) intervention in improving rates of HIV testing, linkage to HIV prevention/care, and PrEP uptake among highest risk contacts recently exposed to HIV. Under this aim, we will conduct a cross-sectional stepped wedge cluster randomized trial in which 12 clusters of NYC neighborhoods are exposed to the intervention sequentially, with three clusters moving from control to intervention every 6 months (n = 1150). Primary outcomes are HIV testing, timely PrEP/ARV uptake, and linkage to PrEP/HIV care. Secondary outcomes are STD testing and receipt of STD treatment (if indicated). (3) Conduct preliminary analyses of economic outcomes, including cost-allocation and affordability to allow other jurisdictions to make decisions about implementation. These analyses will include per-outcome cost-estimates, and will develop a blueprint for economic evaluation of the intervention including incremental cost-effectiveness and budget impact analyses for application locally and nationally. The proposed project is poised to have a significant and sustained impact on the field by: a) addressing a critical gap in the prevention/care continuum to reduce persistent disparities in the epidemic; and b) pioneering a collaborative implementation science approach to accelerate the dissemination of evidence-based practice models across the United States and internationally.

7.项目摘要 该项目与纽约市卫生和心理卫生部（NYC DOHMH）合作， 为已通知的艾滋病毒接触者制定并测试基于实地的全面性健康干预措施， 其合作伙伴服务（即，艾滋病毒接触者追踪）计划。PS计划覆盖的个人是最高优先级 与艾滋病毒预防/护理服务的联系：10-20%是由于PS通知而新诊断出的艾滋病毒感染者 其余的人都有资格获得PrEP的高优先级。因为他们在人群中寻找风险最高的人。 在该领域，PS计划有可能显着减少PrEP吸收和及时艾滋病毒的现有差距 通过接触目前未充分参与传统PrEP或艾滋病毒检测的人群来启动护理 程序.新的合作伙伴服务-性健康（PS-SH）干预提供了一个全面的性 包括艾滋病毒检测、性传播感染检测、抗逆转录病毒/预防前预防教育和立即用药在内的一揽子健康计划开始， 所有接收联系通知的个人（即，被告知最近暴露于艾滋病毒）。NYCDOHMH是 合作开展这项研究项目，以便对干预措施的有效性进行科学严格的测试， 提供有关实施动态、成本效益和可负担性的最高质量数据， 如果干预措施证明是有效的，则进行传播和调整。具体目标是：（1）试点 并完善通过纽约市卫生和家庭健康部合作伙伴提供的基于实地的全面性健康干预措施 服务计划。在这个目标下，我们将在纽约市五个患病率最高的社区进行试点干预 为期6个月（n = ~60），检查可行性和可接受性，并完善干预过程和方案 进行大规模的有效性试验(2)检查伙伴服务-性健康的有效性 （PS-SH）干预措施，以提高艾滋病毒检测率，与艾滋病毒预防/护理的联系， 最近接触过艾滋病毒的高危接触者在此目标下，我们将进行一个横截面阶梯楔 一项随机分组试验，其中12组纽约市社区暴露于干预措施 按顺序，每6个月从对照组转移到干预组（n = 1150）。初级 结果是艾滋病毒检测，及时的PrEP/ARV摄取，以及与PrEP/艾滋病毒护理的联系。次要结局 性病检测和接受性病治疗（如有指征）。(3)进行初步经济分析 结果，包括成本分配和负担能力，以允许其他司法管辖区作出决定， 实施.这些分析将包括每个结果的成本估计，并将制定蓝图， 对干预措施进行经济评价，包括增量成本效益和预算影响分析 适用于本地和全国。拟议的项目将产生重大和持续的影响 （a）解决预防/护理连续体中的一个关键差距， B）开创一种合作实施科学方法， 在美国和国际上传播基于证据的实践模式。