Adaptation, execution, and evaluation of a differentiated service delivery model for PMTCT

项目总结/摘要 在全球范围内，每年约有140万例怀孕受到艾滋病毒的影响。东部和南部 在非洲，近三分之一的艾滋病毒感染妇女在怀孕期间开始接受抗逆转录病毒治疗后失去了随访（LTFU） 29-42%的人在产后期间没有维持病毒抑制。区分服务交付（DSD） 世界卫生组织认可的以证据为基础的实施战略，以提高保留率 和抑制艾滋病病毒感染者。渠务署简化和调整艾滋病毒服务，以满足需求 和偏好的临床稳定的客户，允许强化服务提供给不稳定的客户， 是最需要的。然而，预防艾滋病毒母婴传播的DSD模式 缺乏指导DSD适应PMTCT的数据。K23研究的目的是 调整、执行和评估预防母婴传播的DSD模型，以提高保留率和病毒抑制率， 人口中心假设是，保留和病毒抑制是由以下因素的复杂相互作用驱动的： 个人和背景因素对妇女产生不同影响，并影响她们对服务的偏好。 在资源有限的情况下，预防母婴传播方案可以通过为更多的人提供量身定制的服务来改善结果。 使用DSD方法准确有效地满足客户的需求和偏好。具体目标是： (1)通过对孕妇和孕妇进行离散选择实验，确定患者对预防母婴传播服务的偏好， 接受护理或长期护理单位的感染艾滋病毒的产后妇女，并使用这些数据来确定 （2）为预防母婴传播制定一个可持续发展模型，并建立组织准备， 实施，采用以人为本的设计方法，结合利益相关者的观点;（3） 在资源有限的情况下，在一个妇幼保健诊所实施预防母婴传播的人口持续发展模式， 使用RE-AIM/PRISM框架评估模型的实现。这项研究将在 肯尼亚提供医疗保健服务的学术模式（AMPATH），并利用 东非国际艾滋病流行病学评估数据库联盟（EA-IEDEA）。除了 开发新知识，这个K23奖将支持PI的职业发展和培训，约翰博士 汉弗莱，这样他就可以实现他的职业目标。他的职业目标是成为一名独立调查员 在资源有限的情况下改善艾滋病毒成果的执行战略方面具有专门知识， 特别注重防止母婴传播。他的培训目标是：（1）设计优化的实施策略， 离散选择方法和整合多方法研究产生的数据;（2）执行 并利用执行框架评价执行战略。这个K23会提供证据 基于DSD模型的PMTCT，填补了该人群指南和文献中的主要空白。K23 Humphrey博士还将开发R 01，以进行大规模的PMTCT DSD模型试验， EA-IEDEA网络作为独立调查员。

Project Summary/Abstract Globally, approximately 1.4 million pregnancies are impacted by HIV every year. In Eastern and Southern Africa, nearly a third of women living with HIV initiating ART during pregnancy become lost to follow-up (LTFU) and 29-42% do not maintain viral suppression in the postpartum period. Differentiated service delivery (DSD) is an evidence-based implementation strategy endorsed by the World Health Organization to improve retention and viral suppression for people living with HIV. DSD simplifies and adapts HIV services to meet the needs and preferences of clinically stable clients, allowing for intensification of service delivery to unstable clients who are most in need. However, DSD models for prevention of mother to child transmission of HIV (PMTCT) are lacking and data to guide the adaptation of DSD to PMTCT are scarce. The objective of this K23 research is to adapt, execute and evaluate a DSD model for PMTCT to enhance retention and viral suppression for this population. The central hypothesis is that retention and viral suppression are driven by a complex interplay of individual and contextual factors that affect women differently and shape their preferences for services. PMTCT programs in resource-limited settings can improve outcomes by tailoring service delivery to more accurately and efficiently meet clients’ needs and preferences using a DSD approach. The specific aims are: (1) Determine patient preferences for PMTCT services through a discrete choice experiment with pregnant and postpartum women living with HIV who are retained in care or LTFU, and use these data to identify components for the DSD model; (2) Develop a DSD model for PMTCT and build organizational readiness for implementation, using a human-centered design approach that incorporates stakeholders’ perspectives; (3) Execute a DSD model for PMTCT at one maternal and child health clinic in a resource-limited setting, and evaluate the model’s implementation using the RE-AIM/PRISM framework. This research will take place at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya and utilize the research infrastructure of the East Africa International Epidemiology Databases to Evaluate AIDS (EA-IeDEA) Consortium. In addition to developing new knowledge, this K23 award will support the career development and training of the PI, Dr. John Humphrey, so that he can achieve his career goal. His career goal is to become an independent investigator with expertise in implementation strategies to improve HIV outcomes in resource-limited settings, with a specific focus on PMTCT. His training aims are: (1) Designing optimized implementation strategies using discrete choice methodology and integrating data generated through multi-methods research; (2) Executing and evaluating implementation strategies using implementation frameworks. This K23 will yield an evidence- based DSD model for PMTCT, filling a major gap in the guidelines and literature for this population. This K23 will also position Dr. Humphrey to develop an R01 to conduct a large-scale trial of a DSD model for PMTCT in the EA-IeDEA network as an independent investigator.