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.

项目概要/摘要 背景：自愿辅助接触者追踪 (ACT) 是一种基于证据的方法，可有效识别 需要艾滋病毒治疗和预防的人。与撒哈拉以南非洲的许多国家一样，马拉维 采取了 ACT 政策来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的缺陷，马拉维的 ACT 实施情况不佳。 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 解决这些障碍的工人培训和持续质量改进流程； 2）包装这些 将策略融入结合数字和面对面模式的混合学习平台； 3) 现场测试 马拉维的一揽子计划取得了有希望的初步成果。在此提案中，该方案将严格 在马拉维评估了实施情况、服务采用情况和成本效益结果。首要的 假设混合学习 ACT 方案是可行且可以接受的，可以实施、建立健康 工作人员和设施的 ACT 能力，可以对更多的接触者进行艾滋病毒检测，并且在马拉维具有成本效益 语境。目的和方法：通过双臂务实整群随机实施试验， 拟议的研究将通过三个具体目标来解决这些差距。位于两个地区的 20 个马拉维设施 将按照 1:1 的比例随机分配，以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。第一个目标，ACT实施成果 将在增强型和标准型之间进行比较。卫生工作者对 ACT 程序的忠诚度（主要 结果）将通过录音的 ACT 遭遇进行评估。次要结果包括设施 通过强化实施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，将比较增强组和标准组之间的艾滋病毒服务接受结果。这 提供 ACT 的指标数量、引发的接触者数量、接受 HIV 检测的接触者数量（主要 结果），并将比较两组之间被诊断为艾滋病毒阳性的接触者数量。在 第三个目标，将审查成本和成本效益结果。主要结果是增量成本 每个保存的残疾调整生命年。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：该团队由一位具有 ACT 专业知识的新的早期首席研究员领导。该作品是一个 学术机构与位于马拉维的大型 PEPFAR 执行伙伴之间的合作努力 在马拉维卫生部的指导下。该团队拥有艾滋病毒实施、实施等方面的专业知识 科学、基于技术的干预措施、定性和定量研究方法以及成本效益 分析。影响：该提案通过创新的研究问题解决了重大的知识差距 使用精心设计的研究计划。研究结果将为如何建立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。