Assessing Perceptions and Preferences around Long-acting Injectables (APPLI) in the Ryan White HIV/AIDS Program

摘要 莱恩·怀特艾滋病毒/艾滋病方案是减少人们之间健康差距的重要平台 与艾滋病毒(PWH)合作，并扩大基于证据的战略，以加强艾滋病毒护理连续体。我们建议 基于纽约瑞安·怀特A部分(RWPA)计划的实施科学研究，以向 向低血压病患者提供长效注射(LAI)抗逆转录病毒疗法(ART)和相关支持服务 收入，主要是黑人和拉丁裔/a PWH，他们每天都在努力坚持口腔艺术。作为一名少校 生物医学的进步消除了坚持每天服药的必要性，LAI ART可以极大地增加机会 对于健康、生存和传播预防，特别是在面临复杂的病毒障碍的人群中 负载抑制。然而，优化莱茵抗逆转录病毒治疗对公众健康的影响将需要实施科学 评估对LAI的看法和偏好，与日常口服方案相比，确定支持服务和 适合于促进LAI吸收和参与的交付机制，并解决提供商信念的作用 至于应该向哪些患者提供LAI选项。在缺乏这一基础的情况下，赖艺术可能主要 接触到那些已经处于相对优势的人，甚至加剧艾滋病毒的差距。拟议中的项目 目的：(1)引出人们对LAI与日常口头艺术交流的认知、障碍/促进者和期望 在RWPA医疗病例管理(MCM)患者、核心工作人员和处方这六个重点群体中的选项 供应商；(2)量化参与ART交付和支持战略的偏好和驱动因素， 包括LAI和日常口腔艺术的选项，通过对200名患者和200名患者进行离散选择实验(DCES) 供应商；以及(3)选择和试点战略，以促进LAI ART在现实世界中的接受、坚持和影响 护理设置。及时形成对患者和提供者的看法和偏好的工作对于 成功、公平地推出了莱雅艺术。拟议的研究将对障碍和 为威斯康星医院设计的RWPA MCM项目中LAI ART参与的促进者，并有文件证明的遵守情况 障碍。具体地说，焦点小组和DCE将阐明RWPA如何(以及哪些)资助服务(例如， 患者评估、联合护理计划、健康教育、家访和陪同预约) 可应用或调整以提高LAI ART结果。AIM 3试点测试和后续RCT将进一步 通过衡量实施情况和临床情况，向LAI ART交付策略改进和扩展提供信息 拟议项目所产生的战略成果。通过研究所之间的合作伙伴关系 纽约市立大学实施科学与人口健康(ISPH) 卫生署和六家RWPA服务提供商机构、产品建议项目和后续行动 在传播时，将把随机对照试验转化为当地艾滋病毒服务规划和做法的改进 在国内和国际上通过同行评议的出版物、在科学会议和 在纽约ISPH设计/维护的杜绝疫情仪表板网站上张贴。

Abstract The Ryan White HIV/AIDS Program is an essential platform for reducing health disparities among people with HIV (PWH) and scaling up evidence-based strategies to strengthen the HIV care continuum. We propose an implementation-science study based in New York Ryan White Part A (RWPA) programs, to inform the delivery of long-acting injectable (LAI) antiretroviral therapy (ART) and related supportive services to low- income, largely Black and Latino/a PWH who have struggled with daily oral ART adherence. As a major biomedical advance de-necessitating adherence to daily dosing, LAI ART could greatly increase opportunities for health, survival and transmission prevention, particularly in populations confronting complex barriers to viral load suppression. However, optimizing the public health impact of LAI ART will require implementation science to assess perceptions and preferences around LAI versus daily oral regimens, identify support services and delivery mechanisms suited to promoting LAI uptake and engagement, and address the role of provider beliefs as to which patients should be offered LAI options. In the absence of this groundwork, LAI ART may primarily reach those who are already relatively advantaged, and even exacerbate HIV disparities. The proposed project aims to: (1) Elicit perceptions, barriers/facilitators and expectations of LAI versus daily oral ART delivery options, in six focus groups of RWPA medical case management (MCM) patients, core staff and prescribing providers; (2) Quantify preferences and drivers of engagement in ART delivery and support strategies, including options for LAI and daily oral ART, via discrete choice experiments (DCEs) with 200 patients and 200 providers; and (3) Select and pilot strategies to promote LAI ART uptake, adherence and impact in real-world care settings. Timely formative work on patient and provider perceptions and preferences will be essential to a successful, equitable rollout of LAI ART. The proposed study will yield valuable insights into barriers and facilitators of LAI ART engagement in RWPA MCM programs designed for PWH with documented adherence barriers. Specifically, focus groups and DCEs will elucidate how (and which) RWPA-funded services (e.g., for patient assessment, joint care planning, health education, home visits, and accompaniment to appointments) may be applied or adapted to enhance LAI ART outcomes. Aim 3 pilot testing and a follow-up RCT will further inform LAI ART delivery strategy refinement and scale-up, by measuring both implementation and clinical outcomes of strategies emerging from the proposed project. Through a partnership between the Institute for Implementation Science and Population Health (ISPH) at the City University of New York, the New York City Health Department and six RWPA service provider agencies, products from the proposed project and follow-up RCT will be translated to local HIV services planning and practice improvements, while being disseminated nationally and internationally through peer-reviewed publications, presentations at scientific conferences and posting on New York’s ISPH-designed/maintained Ending-the-Epidemic Dashboard website.