Systems analysis and improvement approach to improve integration of HIV prevention and treatment services

提高艾滋病毒预防和治疗服务一体化的系统分析和改进方法

• 批准号: 10597692
• 负责人: McKenna Claire Eastment
• 金额: $ 71.42万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597692
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adopted; Adoption; Africa South of the Sahara; African; Age; Area; Budgets; Caring; Client; Clinic; Cluster randomized trial; Consolidated Framework for Implementation Research; Counseling; County; Data; Dissemination and Implementation; Effectiveness; Family Planning; Family health status; Female Adolescents; Guidelines; HIV; HIV Infections; Health; Health Personnel; Health Policy; Health care facility; Healthcare Systems; Home; Hospitals; Human Resources; Human immunodeficiency virus test; Incidence; Intervention; Kenya; Logic; Maintenance; Maps; Modeling; NIH Office of AIDS Research; Oral; Outcome; Persons; Policies; Politics; Population; Positioning Attribute; Prevalence; Prevention; Primary Care; Procedures; Process; Public Health; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reproductive Health; Research; Research Priority; Services; Sexual Health; Southern Africa; Surveys; Systems Analysis; Testing; Time; Universities; Washington; Woman; Work; aged; budget impact; compare effectiveness; comparison control; comparison intervention; cost; effectiveness evaluation; evidence base; experience; falls; implementation evaluation; implementation facilitators; implementation research; implementation science; implementation strategy; improved; incremental cost; innovation; men; organizational readiness; pre-exposure prophylaxis; prevention service; programs; reproductive; scale up; screening; seropositive; therapy development; tool; treatment arm; treatment as prevention; treatment services; uptake; young woman

East and Southern Africa is home to 6.2% of the world’s population but includes 54% of all people living with HIV (PLWH). In this region, three out of five PLWH are women, and there is a particularly high burden of HIV amongst adolescent girls and young women (AGYW). Over half of African women use family planning (FP) services. Integration of HIV prevention and treatment with FP services holds promise for supporting progress toward the UNAIDS 95-95-95 targets for testing, treatment, and prevention. Nonetheless, integration of even basic HIV prevention and treatment services into FP clinics remains low and how best to integrate these services is still unknown. In a previous trial, the Systems Analysis and Improvement Approach (SAIA), was an effective implementation strategy for improving HIV counseling and testing in a small selection of FP clinics in Mombasa County, Kenya when delivered by research staff. SAIA incorporates a cascade analysis tool, sequential process flow mapping, and cycles of micro-intervention development, implementation, and assessment to improve a care cascade. More data is needed to understand if SAIA is effective for also improving linkage to HIV care and screening and linkage to pre-exposure prophylaxis (PrEP) in FP clinics when SAIA is delivered at scale by Kenyan public health workforce. The first objective of this study is to conduct a cluster-randomized trial evaluating the effectiveness of SAIA versus control (usual procedures with no specific intervention) for increasing HIV counseling, testing, linkage to HIV care, and screening and linkage to PrEP in new FP clients and new and returning AGYW clients. There will be a particular focus on the HIV prevention and treatment of AGYW in this study and any AGYW presenting for FP care will be prioritized. Quantitative and qualitative data will be analyzed using the RE-AIM framework to evaluate the program’s Reach, Effectiveness, Adoption, Implementation, and Maintenance. To understand how SAIA could be integrated into national Ministry of Health policies and programs, activity-based costing will be conducted to estimate the budget and program impacts of SAIA, scaled to a County level, from a Ministry of Health perspective. It is hypothesized that compared to control, SAIA will be effective at increasing HIV counseling, HIV testing, linkage to HIV care, and screening and linkage to PrEP for new FP clients and all new and returning AGYW FP clients when delivered at scale by Kenyan public health staff. The implementation evaluation, costing, and budget impact analysis will establish a road map for national-level implementation, positioning Kenya as a global leader in integrating FP/HIV services.

东非和南部非洲拥有世界6.2%的人口，但包括54%的 艾滋病毒(PLWH)。在该区域，五分之三的妇幼保健员是妇女，艾滋病毒的负担特别重。 在青春期女孩和年轻妇女中(AGYW)。超过一半的非洲妇女使用计划生育(FP) 服务。将艾滋病毒预防和治疗与计划生育服务相结合有望支持进展 向联合国艾滋病规划署95-95-95检测、治疗和预防目标迈进。尽管如此，Even的整合 计划生育诊所的基本艾滋病毒预防和治疗服务仍然很低，以及如何最好地整合这些服务 服务仍然是未知的。在以前的试验中，系统分析和改进方法(SAIA)是一种 改善青岛市部分计划生育门诊艾滋病咨询检测工作的有效实施策略 蒙巴萨县，肯尼亚，由研究人员提供。SAIA结合了级联分析工具， 顺序流程图和微干预的开发、实施和循环 评估以改善护理级联。需要更多的数据来了解SAIA是否也适用于 改善与艾滋病护理和筛查的联系以及与计划生育诊所暴露前预防(PrEP)的联系 当肯尼亚公共卫生工作人员大规模提供SAIA时。这项研究的第一个目标是 进行一项整群随机试验，评估SAIA与对照的有效性(通常程序为 没有具体干预措施)，以增加艾滋病毒咨询、检测、与艾滋病毒护理的联系以及筛查和联系 到新的FP客户端以及新的和返回的AGYW客户端中的PrEP。将特别关注艾滋病毒 本研究中的AGYW的预防和治疗以及任何针对FP护理的AGYW将被优先考虑。 将使用RE-AIM框架分析定量和定性数据，以评估该计划的 覆盖范围、有效性、采用、实施和维护。为了理解赛亚是如何 纳入国家卫生部政策和方案，将进行基于活动的成本计算 估计卫生部的SAIA的预算和方案影响，扩展到县一级 透视。据推测，与对照组相比，SAIA将有效地增加艾滋病毒咨询， 艾滋病毒检测，与艾滋病毒护理的联系，以及为新的FP客户和所有新的和 当肯尼亚公共卫生人员大规模交付时，正在退还AGYW FP客户。实施 评价、成本计算和预算影响分析将为国家一级的实施确定路线图， 将肯尼亚定位为整合计划生育/艾滋病毒服务的全球领导者。