Investigating the impact of preference-concordant differentiated service delivery for HIV

调查偏好一致的差异化服务提供对艾滋病毒的影响

• 批准号: 10619804
• 负责人: Hae-Young Kim
• 金额: $ 18.06万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619804
• 关键词: Address; Adherence; Adopted; Affect; Africa South of the Sahara; Area; Berry; Caring; Categories; Characteristics; Client; Clinic; Clinic Visits; Clinical; Communities; Continuity of Patient Care; Country; Decision Making; Disclosure; Education; Eligibility Determination; Environment; Epidemic; Epidemiology; Evaluation; Goals; Guidelines; HIV; Health; Health care facility; Home; Human Resources; Individual; Institution; International; Intervention; Kenya; Measurement; Measures; Mentored Research Scientist Development Award; Mentorship; Observational Study; Outcome; Patient Preferences; Patient-Focused Outcomes; Patients; Persons; Policies; Population; Privacy; Privatization; Prospective, cohort study; Provider; Psychosocial Factor; Qualitative Research; Quality of life; Research; Research Personnel; Research Project Grants; Science; Services; Social support; South Africa; Statistical Methods; Structure; Study models; Training; Viral; Viral Load result; Work; World Health Organization; Zambia; antiretroviral therapy; career; career development; community based care; comparative cost effectiveness; comparative effectiveness; cost; cost effective; design; dissemination science; experience; experimental study; group counseling; implementation science; improved; low and middle-income countries; mathematical model; medical schools; men; outreach; patient oriented; preference; programs; prospective; service delivery; skills; social; social stigma; symposium; transmission process; treatment adherence; treatment group

Background. Differentiated service delivery (DSD) for HIV care, an approach to better serve clinical and social needs among people living with HIV (PLWH), has been adopted to improve adherence and retention in care. The current DSD programs include four different categories (within-facility individual, out-of-facility individual, provider-managed group, client-managed group). Studies have so far shown mixed results of DSD relative to conventional ART delivery. In 2021, the World Health Organization revised its guideline to expand DSD to offer more individualized HIV services to all PLWH. Currently, DSD individualization is often based on clinical stability or availability of human resources, rather than patient preferences and needs. As countries expand DSD, preference-based individualization of DSD could improve health outcomes and quality of life. This K01 provides a unique opportunity to address these research gaps. Candidate Overview. My long-term career objective is to become an independent investigator who specializes in incorporating patient-centeredness into health programs for PLWH in low- and middle-income countries. While I have developed research skills in epidemiology, statistical methods, discrete choice experiments and preference assessment, this K01 award will provide the necessary additional training and experience to be an independent investigator in the design and evaluation of patient-centered health programs to improve clinical outcomes and quality of life among PLWH and inform policy decision-making. Career Development and Training Plan. My educational program includes structured coursework, professional conferences, directed readings, and a research project with specific aims timed to coincide with these activities. My mentorship team includes international experts who specialize in areas related to my training goals: Dr. Scott Braithwaite (decision science and comparative effectiveness), Dr. Anna Bershteyn (agent-based mathematical modeling), Dr Carolyn Berry (qualitative research), Dr. Elvin Geng (implementation science), and Dr. Elizabeth Bukusi (study execution and dissemination in Kenya). Environment. NYU School of Medicine provides an exceptional environment to conduct the proposed study, obtain additional training and mentorship, and successfully transition to an independent investigator. Research Strategy. My study will evaluate the impact of preference-concordant programs on patient and population outcomes using a prospective cohort study and mathematical modeling in western Kenya. Specifically, the study will: 1) measure the trade-offs that patients are willing to make among different features of DSD programs and how these preferences vary by patient characteristics; 2) determine how preference- concordant DSD programs impact retention, adherence, and viral load suppression; 3) estimate the long-term health impact and costs of preference-concordant DSD programs using mathematical modeling.

背景。 HIV 护理的差异化服务提供 (DSD)，一种更好地服务于临床和社会的方法 艾滋病毒感染者 (PLWH) 的需求已被采用，以提高护理的依从性和保留率。 当前的 DSD 计划包括四个不同的类别（设施内个人、设施外个人、 提供商管理的组、客户管理的组）。迄今为止的研究表明，DSD 相对于 传统的 ART 交付。 2021 年，世界卫生组织修订了指南，将 DSD 的范围扩大到 为所有感染者提供更个性化的艾滋病毒服务。目前，DSD个体化通常基于临床 人力资源的稳定性或可用性，而不是患者的偏好和需求。随着国家的扩张 DSD，基于偏好的 DSD 个性化可以改善健康结果和生活质量。这个K01 为解决这些研究空白提供了独特的机会。 候选人概述。我的长期职业目标是成为一名专门从事研究的独立调查员 将以患者为中心纳入低收入和中等收入国家的 PLWH 卫生计划中。 虽然我已经发展了流行病学、统计方法、离散选择实验和 偏好评估，该 K01 奖项将提供必要的额外培训和经验，成为一名 设计和评估以患者为中心的健康计划以改善临床的独立研究者 PLWH 的结果和生活质量，并为政策决策提供信息。 职业发展和培训计划。我的教育计划包括结构化课程， 专业会议、定向阅读和具有特定目标的研究项目，时间与 这些活动。我的导师团队包括专门从事与我相关领域的国际专家 培训目标：Scott Braithwaite 博士（决策科学和比较有效性）、Anna Bershteyn 博士 （基于代理的数学建模）、Carolyn Berry 博士（定性研究）、Elvin Geng 博士（实施 科学）和 Elizabeth Bukusi 博士（肯尼亚的研究执行和传播）。 环境。纽约大学医学院提供了一个特殊的环境来进行拟议的研究， 获得额外的培训和指导，并成功过渡为独立调查员。 研究策略。我的研究将评估偏好一致的计划对患者和患者的影响 使用肯尼亚西部的前瞻性队列研究和数学模型得出的人口结果。 具体来说，该研究将：1）衡量患者愿意在不同特征之间做出的权衡 DSD 计划以及这些偏好如何根据患者特征而变化； 2）确定如何偏好- 一致的 DSD 计划会影响保留、依从性和病毒载量抑制； 3）估计长期 使用数学模型分析符合偏好的 DSD 计划的健康影响和成本。