Enhancing HIV assisted contact tracing in Malawi through blended learning: An Implementation Science Study

通过混合学习加强马拉维艾滋病毒辅助接触者追踪：一项实施科学研究

• 批准号: 10626785
• 负责人: Nora Rosenberg
• 金额: $ 52.09万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-23 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10626785
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adopted; Adoption; Africa South of the Sahara; Biological; Caring; Characteristics; Child; Client; Clinical; Collaborations; Contact Tracing; Cost Effectiveness Analysis; Counseling; Country; Data; Decision Trees; Diagnosis; E-learning; Emergency Situation; Epidemic; Feedback; Goals; Guidelines; HIV; HIV Seronegativity; HIV Seropositivity; Health; Health care facility; Human immunodeficiency virus test; Hybrids; Inservice Training; Institution; Intervention; Knowledge; Lead; Learning; Link; Malawi; Methods; Modality; Modeling; Outcome; Patient Recruitments; Patients; Persons; Play; Policies; Population; Prevention; Principal Investigator; Problem Solving; Procedures; Process; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Design; Research Methodology; Role; Services; Sexual Partners; Structure; Tablets; Technology; Testing; Thinking; Training; Viral; Work; World Health Organization; acceptability and feasibility; arm; budget impact; condoms; cost; cost effective; cost effectiveness; digital; disability-adjusted life years; effectiveness outcome; epidemic response; evidence base; field study; health organization; human centered design; implementation outcomes; implementation research; implementation science; implementation strategy; implementation trial; improved; incremental cost; indexing; innovation; insight; low and middle-income countries; markov model; pilot test; primary outcome; process improvement; programs; prospective; randomized trial; recruit; secondary outcome; service uptake; skills; social cognitive theory; theories; tool

Project Summary/Abstract Background: Voluntary assisted contact tracing (ACT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention. Malawi, like many countries in sub-Saharan Africa, has adopted ACT policies to support its “95-95-95” targets for HIV testing, treatment, and viral suppression. However, Malawi’s ACT implementation has been poor due to deficits in health worker capacity and clinical coordination. Through preliminary work, our team has 1) developed a set of implementation strategies (theory-based health worker training and continuous quality improvement processes) that address these barriers; 2) packaged these strategies into a blended learning platform that combines digital and face-to-face modalities; and 3) field-tested the package in Malawi with promising preliminary results. In this proposal, the package will be rigorously evaluated in Malawi for implementation, service uptake, and cost-effectiveness outcomes. The overarching hypothesis is that the blended learning ACT package will be feasible and acceptable to implement, build health worker and facility ACT capacity, lead to more contacts tested for HIV, and be cost-effective in the Malawian context. Aims and Methods: Through a two-arm pragmatic cluster randomized implementation trial, the proposed research will address these gaps through three specific aims. Twenty Malawian facilities in two districts will be randomized 1:1 to receive the blended learning implementation package (enhanced) versus standard implementation package (standard) and followed for two years. In the first aim, ACT implementation outcomes will be compared between the enhanced and standard arms. Health worker fidelity to ACT procedures (primary outcome) will be assessed through audio-recorded ACT encounters. Secondary outcomes include facility adoption of the enhanced implementation strategy, as well as health worker feasibility and acceptability. In the second aim, HIV service uptake outcomes will be compared between the enhanced and standard arms. The number of indexes offered ACT, number of contacts elicited, number of contacts tested for HIV (primary outcome), and number of contacts diagnosed as HIV-positive will be compared between the two arms. In the third aim, cost and cost-effectiveness outcomes will be examined. The primary outcome is the incremental cost per disability adjusted life year saved. This will be estimated in the trial population and projected nationally. Team: The team is led by a new and early stage Principal Investigator with ACT expertise. The work is a collaborative endeavor between academic institutions and a large Malawi-based PEPFAR implementing partner with guidance from the Malawi Ministry of Health. The team has expertise in HIV implementation, implementation science, technology-based interventions, qualitative and quantitative research methods, and cost-effectiveness analysis. Impact: This proposal addresses a significant knowledge gap via an innovative research question using a well-designed research plan. The findings will offer important insights and innovations into how to bridge the gap between ACT research and practice, a critical step towards achieving the 95-95-95 targets.

项目摘要/摘要 背景：自愿协助接触者追踪(ACT)是一种基于证据的方法，可以有效地识别 需要艾滋病毒治疗和预防的人。像撒哈拉以南非洲的许多国家一样，马拉维拥有 通过了ACT政策以支持其艾滋病毒检测、治疗和病毒抑制的“95-95-95”目标。然而， 由于卫生工作者能力和临床协调方面的不足，马拉维的ACT执行情况一直很差。 通过前期工作，我们团队1)制定了一套实施策略(基于理论的健康 工人培训和持续质量改进流程)，以解决这些障碍；2)打包这些 将战略整合到混合学习平台中，将数字和面对面的形式结合在一起；以及3)经过实地测试 马拉维的一揽子计划取得了可喜的初步成果。在这项提案中，一揽子计划将严格 在马拉维对执行情况、服务接受情况和成本效益结果进行了评估。最重要的是 假设是，混合学习ACT方案将是可行的和可接受的，以实施，建立健康 工作人员和设施的能力，导致更多的接触者接受艾滋病毒检测，并在马拉维具有成本效益 背景。目的和方法：通过两臂实用整群随机实施试验， 拟议的研究将通过三个具体目标解决这些差距。设在两个区的20个马拉维设施 将以1：1随机方式获得混合学习实施包(增强版)与标准版 实施包(标准)，并遵循两年。在第一个目标中，《行动计划》的执行结果 将在增强型和标准型武器之间进行比较。卫生工作者对ACT程序的忠诚度(主要 结果)将通过ACT会议的录音进行评估。次要结果包括设施 采用强化执行战略，以及卫生工作者的可行性和可接受性。在 第二个目标是，将比较增强型和标准型武器的艾滋病毒服务吸收结果。这个 提供ACT的指数数、引发的接触数、检测HIV的接触数(主要 结果)，以及被诊断为艾滋病毒阳性的接触者的数量将在两个手臂之间进行比较。在 将审查第三个目标、成本和成本效益结果。主要结果是增量成本 每个伤残调整后的生命年已保存。这将在试验人群中进行估计，并在全国范围内进行预测。 团队：团队由一名具有ACT专业知识的新的早期首席调查员领导。这项工作是一项 学术机构与设在马拉维的大型PEPFAR执行伙伴之间的合作努力 在马拉维卫生部的指导下。该团队在艾滋病毒实施、实施 科学、以技术为基础的干预措施、定性和定量研究方法以及成本效益 分析。影响：这项建议通过一个创新的研究问题解决了一个重大的知识差距 使用精心设计的研究计划。这些发现将为如何搭建桥梁提供重要的见解和创新 ACT研究与实践之间的差距，是实现95-95-95目标的关键一步。