Philadelphia Cooperative Agreement Re-engagement Controlled Trial

描述（由申请人提供）：为了实现艾滋病毒感染者的最佳健康结果，必须完成艾滋病毒治疗连续体沿着几个步骤-诊断，与护理联系，保持护理，使用抗逆转录病毒疗法（ART）和病毒抑制。 这个项目，合作协议重新参与对照试验（CoRECT）的目的是展示一个具有成本效益的模式，通过卫生部领导的外展工作，改善艾滋病毒医疗护理的人谁已经失去了照顾。这种模式可以被美国各地的卫生部门采用，作为一项公共卫生计划，以改善艾滋病毒护理和减少艾滋病毒传播。费城公共卫生部（PDPH）将在5年内证明由PDPH和费城市的六个合作艾滋病毒诊所联合实施的积极护理重新参与干预的可行性，这些诊所包括Ryan White资助的私人诊所，联邦合格健康中心（FHEDHC）和退伍军人管理局。通过综合诊所和艾滋病毒监测数据确定为最近脱离护理的患者将被随机分配到卫生部门的积极重新参与干预或标准护理诊所随访。估计将从合作诊所的近5 000名艾滋病毒患者中确定600名脱离护理的患者（每组300名）。CoRECT的主要结局将评估与接受常规服务的患者相比，主动干预组的患者是否更有可能在研究干预后12个月内实现病毒载量抑制。这项研究的方法是创新的，计划使用监测数据，患者水平的临床数据，并定位数据库，以开发护理艾滋病毒阳性患者名册。在主动重投服务组，�生署人员会寻找因照顾而失去服务的病人，并提供密集的重投服务。将向所有患者提供标准治疗诊所级别的联系和参与服务，包括在患者预约之前给患者打电话提醒，在错过预约后进行主动随访（即电话、信件等）。参与的诊所必须接受卫生部通过干预部门转介的当天或预约。费城将是进行CoRECT研究的三个项目地区之一。费城是美国第六大人口城市，估计艾滋病毒感染率为1.3%。在费城被诊断为艾滋病毒感染者的19，832人中，估计有54%没有接受定期的艾滋病毒医疗护理。公共卫生部制定了一项全面的艾滋病毒方案，以应对这一流行病，并在卫生部内部和一系列签约提供机构中高度协调高质量的艾滋病毒监测、临床护理和伙伴服务。PDPH已成功实施了类似项目，并将根据这一经验实施CoRECT。该项目的调查结果将用于当地的艾滋病毒规划，并提交同行评审期刊和专业会议发表。

DESCRIPTION (provided by applicant): To achieve optimal health outcomes for persons living with HIV, several steps along the HIV treatment continuum -- diagnosis, linkage to care, retention in care, use of antiretroviral therapy (ART), and viral suppression -- must be fulfilled. This project, Cooperative Agreement Re-Engagement Controlled Trial (CoRECT) seeks to demonstrate a cost-effective model for improving retention in HIV medical care through Health Department-lead outreach efforts for persons who have fallen out of care. This model could be adopted by Health Departments throughout the United States as a public health program to improve HIV care and reduce HIV transmission. The Philadelphia Department of Public Health (PDPH) will demonstrate over a 5-year period the feasibility of an active care re-engagement intervention jointly implemented by PDPH and six collaborating HIV clinics in the City of Philadelphia which include Ryan White-funded, private, FQHC (Federally Qualified Health Center), and Veterans Administration settings. Patients identified as recently out of care through combined clinic and HIV surveillance data will be randomized to either an active re-engagement intervention from the Health Department or standard of care clinic follow-up. An estimated 600 out of care patients will be identified (300 per arm) from among nearly 5,000 total HIV patients of the collaborating clinics. The primary outcome for CoRECT will evaluate whether patients in the active intervention arm are more likely to achieve viral load suppression within 12 months of the study intervention compared with those receiving usual services. The study's methods are innovative in its planned use of surveillance data, patient-level clinical data, and locating databases to develop rosters of out of care HIV-positive patients. In the active re- engagement arm, Health Department staff will locate clients lost to care and provide intensive re-engagement services. Standard of care clinic-level linkage and engagement services will be provided to all patients and include reminder calls to patients prior to their scheduled appointments, active follow up after missed appointments (i.e. phone calls, letters, etc.). Participating clinics must accept same-day or walk-in appointments referred from the Health Department through the intervention arm. Philadelphia will be one of three project areas conducting the CoRECT study. Philadelphia is the sixth most populous city in the US with an estimated HIV infection rate of 1.3%. Of the 19,832 persons diagnosed with HIV living in Philadelphia, an estimated 54% are not receiving regular HIV medical care. PDPH has developed a comprehensive HIV program to address the epidemic and high quality HIV surveillance, clinical care and partner services are highly coordinated both within the Health Department and in a continuum of contracted provider agencies. PDPH has successfully implemented similar projects and will implement CoRECT based on this experience. Findings from the project will be used in local HIV planning, submitted for publication in peer-reviewed journals as well as professional meetings.