Managed Problem Solving for ART Adherence and HIV Care Retention Delivered by Community Health Workers: A Stepped Wedge Hybrid Type II Effectiveness Implementation Trial

项目总结/摘要 为了实现结束艾滋病毒流行（EHE）的理想目标，循证实践（EBP）增加了病毒感染率。 必须在全国范围内有效地进行镇压。管理式问题解决（MAPS） 干预是改变艾滋病毒感染者（PLWH）行为的EBP。为了实现这一目标， 应用程序，我们利用费城公共卫生部与 （PDPH）和参与诊所（n = 12），这增强了我们方法的可持续性。我们建议 MAPS可以由经过培训的社区卫生工作者（CHW）提供。使用CHW提供MAPS是 这是因为他们有能力与客户建立信任关系，而且在忙碌的工作中需要转换任务。 诊所。为了解决护理中的保留问题，我们将调整MAPS，使其也专注于解决问题的活动 专门针对护理保留（现称为MAPS+）。社区卫生工作者将设在诊所，以实施MAPS+， 改善病毒抑制和保持对PLWH的护理。数据到护理允许识别那些 并将这些患者重新联系起来。目前，艾滋病毒护理中的药物依从性和保留率 没有针对性的数据到护理，所以我们将建立在这种方法，以促进识别艾滋病毒携带者谁是外出 不进行病毒抑制，为他们提供MAPS+。我们的实施战略包括： 将MAPS+的交付转移到CHW，提供CHW培训和持续支持，并增加 通过标准化协议在CHW和医疗护理团队之间进行通信。我们将进行一次混合 II型有效性-实施试验，在12家诊所采用阶梯楔形分组随机设计， 与常规护理相比，MAPS+使用了一套我们认为最能支持的实施策略 实施.每家诊所将随机分配至三个实施开始时间之一。我们将收集基线 每个诊所6个月的（常规护理）数据，然后是MAPS+和我们的实施方案包 在三个队列中，每个队列有4个诊所，为期12个月。目的1将测试MAPS+在临床上的有效性 有效性结局，包括病毒抑制（主要）和保留（次要）。目标2将审查 一揽子执行战略对reach的影响。我们还将衡量实施成本。目标3 我将采用定性的方法来理解我们实施的过程、机制和可持续性 approach.我们的研究结果将指导未来在艾滋病护理连续体中实施行为EBP的努力， 与EHE的“治疗”支柱一致，并将实施服务的科学与NIH一致 战略优先事项。

Project Summary/Abstract To achieve aspirational goals to end the HIV epidemic (EHE), evidence-based practices (EBPs) to increase viral suppression must be implemented effectively nationally. The Managed Problem Solving (MAPS) behavioral intervention is an EBP for behavior change in people living with HIV (PLWH). To accomplish the goals of this application, we leverage a data-to-care partnership between the Philadelphia Department of Public Health (PDPH) and participating clinics (n = 12), which enhances the sustainability of our approach. We propose that MAPS can be delivered by trained Community Health Workers (CHWs). The use of CHWs to deliver MAPS is justified by their ability to develop trusting relationships with their clients and the need for task shifting in busy clinics. In order to also address retention in care, we will adapt MAPS to also focus on problem solving activities tailored toward retention in care (now termed MAPS+). CHWs will be located in clinics to implement MAPS+ to improve viral suppression and care retention in PLWH. Data-to-care allows for identification of people who are lost to care and link these patients back to care. Currently, medication adherence and retention in HIV care are not targeted in data-to-care so we will build on this approach to facilitate the identification of PLWH who are out of care and not virally suppressed to offer them MAPS+. Our set of implementation strategies include task- shifting the delivery of MAPS+ to CHWs, providing the CHWs training and ongoing support, and increasing communication between the CHWs and medical care team via standardized protocols. We will conduct a hybrid type II effectiveness-implementation trial with a stepped-wedge cluster randomized design in 12 clinics to test MAPS+ compared to usual care using a set of implementation strategies that we believe will best support implementation. Each clinic will be randomized to one of three implementation start times. We will collect baseline (usual care) data from each clinic for 6 months, followed by MAPS+ and our package of implementation strategies for 12 months, in three cohorts of 4 clinics each. Aim 1 will test the effectiveness of MAPS+ on clinical effectiveness outcomes, including viral suppression (primary) and retention (secondary). Aim 2 will examine the effect of the package of implementation strategies on reach. We will also measure implementation cost. Aim 3 will apply a qualitative approach to understand processes, mechanisms, and sustainment of our implementation approach. Our results will guide future efforts to implement behavioral EBPs across the HIV care continuum, consistent with the “treat” pillar of EHE, and move the science of implementation services, consistent with NIH strategic priorities.