Assessing Perceptions and Preferences around Long-acting Injectables (APPLI) in the Ryan White HIV/AIDS Program

评估 Ryan White HIV/AIDS 项目中对长效注射剂 (APPLI) 的看法和偏好

• 批准号: 10598553
• 负责人: Mary Kathryn Irvine
• 金额: $ 10.11万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-16 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10598553
• 关键词: Acceleration; Achievement; Address; Adherence; Administrator; Appointment; Area; Belief; Black race; Caring; Case Management; Case Manager; Cities; Client satisfaction; Clinical; Complex; Continuity of Patient Care; County; Data; Disparity; Dose; Effectiveness; Ensure; Epidemic; Equity; Ethnic Origin; Evidence based intervention; Focus Groups; Funding; Goals; Government; HIV; HIV disparities; HIV therapy; HIV/AIDS; Health; Health Personnel; Health education; Heterogeneity; Home visitation; Injectable; Injections; International; Intervention; Interview; Joints; Latino; Low income; Maintenance; Marketing; Measures; Medical; New York; New York City; Oral; Outcome; Outcome Measure; Patients; Peer Review; Perception; Persons; Phase III Clinical Trials; Play; Population; Prevention; Primary Care; Protocols documentation; Provider; Public Health; Publications; Race; Randomized, Controlled Trials; Reduce health disparities; Regimen; Reporting; Risk; Role; Rural; Safety; Sampling; Scientific Advances and Accomplishments; Self Management; Service delivery model; Services; Specific qualifier value; Surveys; System; Translating; United States Health Resources and Services Administration; United States National Institutes of Health; Universities; Viral; Viral Load result; Vulnerable Populations; Work; antiretroviral therapy; care coordination; dashboard; demographics; design; effectiveness/implementation hybrid; evidence base; expectation; experience; experimental study; field study; follow-up; health equity; implementation outcomes; implementation research; implementation science; implementation strategy; improved; innovation; insight; medical appointment; new technology; next generation; operation; panacea; patient oriented; patient population; pilot test; population health; preference; programs; scale up; service delivery; service providers; service utilization; suburb; symposium; therapy adherence; therapy design; therapy outcome; tool; transmission process; uptake; web site

Abstract The Ryan White HIV/AIDS Program is an essential platform for reducing health disparities among people with HIV (PWH) and scaling up evidence-based strategies to strengthen the HIV care continuum. We propose an implementation-science study based in New York Ryan White Part A (RWPA) programs, to inform the delivery of long-acting injectable (LAI) antiretroviral therapy (ART) and related supportive services to low- income, largely Black and Latino/a PWH who have struggled with daily oral ART adherence. As a major biomedical advance de-necessitating adherence to daily dosing, LAI ART could greatly increase opportunities for health, survival and transmission prevention, particularly in populations confronting complex barriers to viral load suppression. However, optimizing the public health impact of LAI ART will require implementation science to assess perceptions and preferences around LAI versus daily oral regimens, identify support services and delivery mechanisms suited to promoting LAI uptake and engagement, and address the role of provider beliefs as to which patients should be offered LAI options. In the absence of this groundwork, LAI ART may primarily reach those who are already relatively advantaged, and even exacerbate HIV disparities. The proposed project aims to: (1) Elicit perceptions, barriers/facilitators and expectations of LAI versus daily oral ART delivery options, in six focus groups of RWPA medical case management (MCM) patients, core staff and prescribing providers; (2) Quantify preferences and drivers of engagement in ART delivery and support strategies, including options for LAI and daily oral ART, via discrete choice experiments (DCEs) with 200 patients and 200 providers; and (3) Select and pilot strategies to promote LAI ART uptake, adherence and impact in real-world care settings. Timely formative work on patient and provider perceptions and preferences will be essential to a successful, equitable rollout of LAI ART. The proposed study will yield valuable insights into barriers and facilitators of LAI ART engagement in RWPA MCM programs designed for PWH with documented adherence barriers. Specifically, focus groups and DCEs will elucidate how (and which) RWPA-funded services (e.g., for patient assessment, joint care planning, health education, home visits, and accompaniment to appointments) may be applied or adapted to enhance LAI ART outcomes. Aim 3 pilot testing and a follow-up RCT will further inform LAI ART delivery strategy refinement and scale-up, by measuring both implementation and clinical outcomes of strategies emerging from the proposed project. Through a partnership between the Institute for Implementation Science and Population Health (ISPH) at the City University of New York, the New York City Health Department and six RWPA service provider agencies, products from the proposed project and follow-up RCT will be translated to local HIV services planning and practice improvements, while being disseminated nationally and internationally through peer-reviewed publications, presentations at scientific conferences and posting on New York’s ISPH-designed/maintained Ending-the-Epidemic Dashboard website.

摘要