Philadelphia Cooperative Agreement Re-engagement Controlled Trial

描述(由申请人提供)：为了使艾滋病毒携带者获得最佳的健康结果，必须完成艾滋病毒治疗连续过程中的几个步骤--诊断、与护理的联系、保留护理、使用抗逆转录病毒疗法(ART)和病毒抑制。 该项目名为合作协议重新参与受控试验(CORECT)，旨在展示一种成本效益高的模式，通过卫生部牵头的外联努力，改善艾滋病毒医疗保健的留存率，帮助那些失去护理的人。这种模式可以被美国各地的卫生部门作为一项公共卫生计划来采用，以改善艾滋病毒护理并减少艾滋病毒传播。费城公共卫生部(PDPH)将在5年内展示由PDPH和费城六家合作艾滋病毒诊所联合实施的积极护理再参与干预措施的可行性，这六家诊所包括瑞安·怀特资助的私人诊所、联邦合格健康中心(FQHC)和退伍军人管理局机构。通过联合临床和艾滋病毒监测数据被确定为最近出院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后续行动中。估计将从合作诊所的近5,000名艾滋病毒患者中确定600名未得到护理的患者(每只手臂300名)。CORECT的主要结果将评估，与接受常规服务的患者相比，积极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，它有计划地使用监测数据、患者水平的临床数据和定位数据库来制定未得到护理的艾滋病毒阳性患者的花名册。在积极的再参与部门，卫生署工作人员将找到失去照顾的客户，并提供密集的再参与服务。将为所有患者提供标准护理诊所层面的联系和参与服务，包括在患者预定预约之前致电提醒他们，并在错过预约后主动跟进(如电话、信件等)。参与计划的诊所必须接受卫生署透过介入服务部门转介的当日预约或不预约预约。费城将是进行这项正确研究的三个项目地区之一。费城是美国第六大人口城市，艾滋病毒感染率估计为1.3%。在居住在费城的19832名被诊断为艾滋病毒携带者中，估计有54%的人没有接受常规的艾滋病毒医疗护理。PDPH已经制定了一项全面的艾滋病毒计划来应对这一流行病，高质量的艾滋病毒监测、临床护理和合作伙伴服务在卫生部内部和一系列合同提供商机构中都得到了高度协调。PDPH已经成功地实施了类似的项目，并将根据这一经验实施CORECT。该项目的结果将用于当地的艾滋病毒规划，提交给同行评议的期刊以及专业会议发表。

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.