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

PMTCT 差异化服务提供模式的调整、执行和评估

• 批准号: 10611324
• 负责人: John M Humphrey
• 金额: $ 14.39万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-09 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10611324
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Africa; Applied Research; Breastfed infant; Caring; Client; Clinic; Clinical; Communicable Diseases; Complex; Data; Databases; Development; Eastern Africa; Educational workshop; Epidemiology; Evaluation; Goals; Guidelines; HIV; Health; Horizontal Disease Transmission; Human immunodeficiency virus test; Implementation readiness; Individual; Internal Medicine; International; Kenya; Knowledge; Literature; Maternal and Child Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Mission; Modeling; Morbidity - disease rate; Mother-to-child HIV transmission; National Institute of Child Health and Human Development; Outcome; Patient Preferences; Pediatrics; Persons; Population; Positioning Attribute; Postpartum Period; Postpartum Women; Practical Robust Implementation and Sustainability Model; Pregnancy; Pregnant Women; Prevention; Prevention therapy; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Infrastructure; Research Methodology; Research Personnel; Research Priority; Resource-limited setting; Risk; Service delivery model; Services; Shapes; Southern Africa; Time; Training; United States National Institutes of Health; Viral; Woman; World Health Organization; adverse pregnancy outcome; antenatal; antiretroviral therapy; career; career development; clinical infrastructure; contextual factors; data integration; design; disability; evidence base; experience; experimental study; follow-up; health care availability; human centered design; implementation evaluation; implementation framework; implementation outcomes; implementation research; implementation strategy; improved; improved outcome; infant outcome; male; mortality; organizational readiness; patient oriented; preference; programs; service delivery; skills; stakeholder perspectives; transmission process

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.

项目概要/摘要 在全球范围内，每年约有 140 万次怀孕受到艾滋病毒的影响。在东部和南部 非洲，近三分之一的艾滋病毒感染者在怀孕期间开始接受抗逆转录病毒治疗后失去随访（LTFU） 29-42% 的人在产后没有维持病毒抑制。差异化服务交付（DSD）是 世界卫生组织认可的基于证据的实施策略，旨在提高保留率 以及对艾滋病毒感染者的病毒抑制。渠务署简化并调整艾滋病毒服务以满足需求 和临床稳定客户的偏好，从而可以加强向不稳定客户提供的服务 是最需要的。然而，预防艾滋病毒母婴传播 (PMTCT) 的 DSD 模型尚不成熟。 缺乏指导 DSD 适应 PMTCT 的数据。这项 K23 研究的目的是 适应、执行和评估 PMTCT 的 DSD 模型，以增强其保留和病毒抑制 人口。中心假设是保留和病毒抑制是由复杂的相互作用驱动的 对妇女产生不同影响并影响她们对服务的偏好的个人和背景因素。 资源有限环境中的预防母婴传播计划可以通过根据更多情况调整服务提供来改善结果 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 PMTCT 服务的偏好 留在护理机构或 LTFU 中的感染艾滋病毒的产后妇女，并使用这些数据来识别 DSD 模型的组件； (2) 制定 PMTCT 的 DSD 模型并为 PMTCT 做好组织准备 实施，采用以人为本的设计方法，结合利益相关者的观点； (3) 在资源有限的一个妇幼保健诊所实施 PMTCT 的 DSD 模型，以及 使用 RE-AIM/PRISM 框架评估模型的实施。这项研究将在 肯尼亚提供医疗保健的学术模型 (AMPATH) 并利用 东非艾滋病评估国际流行病学数据库 (EA-IeDEA) 联盟。此外 开发新知识，这个 K23 奖项将支持 PI John 博士的职业发展和培训 汉弗莱，这样他就能实现自己的职业目标。他的职业目标是成为一名独立调查员 具有实施战略方面的专业知识，以改善资源有限环境中的艾滋病毒结果， 特别关注 PMTCT。他的培训目标是：（1）使用设计优化实施策略 离散选择方法和整合通过多种方法研究产生的数据； (2) 执行 并使用实施框架评估实施策略。这个 K23 将产生一个证据—— 基于 DSD 模型的 PMTCT，填补了该人群指南和文献中的主要空白。这个K23 还将让 Humphrey 博士开发 R01，以对 PMTCT 的 DSD 模型进行大规模试验 作为独立调查员加入 EA-IeDEA 网络。