Adapting Peer Navigation for Out-of-Care Older Persons with HIV in Ukraine

在50岁以上的550万老年艾滋病毒感染者中，80%生活在低收入和中等收入国家 （LMIC）。乌克兰是东欧和中亚的一个象征性的低收入国家，是世界上唯一一个 艾滋病毒的发病率和死亡率不断上升。在乌克兰24万名PWH中，OPWH占25% 艾滋病毒感染者，但<30%的人在诊断后6个月内与抗逆转录病毒疗法有关， 因此，死亡率比年龄匹配的一般人群高3-11倍。 OPWH参与抗逆转录病毒治疗的主要障碍包括药物使用障碍、抑郁症和艾滋病毒污名。 总统防治艾滋病紧急救援计划将OPWH作为优先干预目标，因为只有43%的妇女和34%的男子 2019年接受ART。OPWH尤其受到COVID-19的影响。2020年5月，我们的电话调查 在123名OPWH中，有58%的人在艾滋病毒护理方面需要援助。实现95-95-95艾滋病毒目标 到2030年，乌克兰需要有效的战略来（重新）参与和保留OPWH在ART中的作用。 差异化的护理模式，同伴导航（PN）是一种以证据为基础的战略，以联系和重新参与OOC PWH， 我们在乌克兰的定性数据表明，OPWH更喜欢同行而不是专业人士参与其中。 艾滋病护理。然而，在资源有限的国家，同行导航尚未针对OPWH进行调整和调整。 尽管从COVID学到的经验教训可能会指导其交付。此外，PN多次被上级 治疗照常（TAU），但在何种程度上，同行/客户的二元有效地相互作用尚未 探讨了我们打算使用ADAPT-ITT（一种循证适应策略）为OPWH定制PN，以创建 PROST（同行运行最佳策略治疗或“你的健康”在乌克兰），并进行试点测试，以（重新- ）让OPWH参与护理和ART。我们假设定制的PROST将更有效地（重新）参与 OPWH和通过克服相对于TAU的独特护理障碍来增加ART的使用。在试点RCT期间 10名经过培训的同行将在12周内向60 OOC OPWH提供PROST，而接收的OOC OPWH为30 τ的将根据既往ART经验对随机化进行分层，并对受试者进行6个月的随访。 结果将包括可接受性、可行性和初步疗效的指标。使用调查项目 基线，第12周和第24周的信任，兼容性和感知质量的同行-客户互动，我们将 对同伴和客户进行二元分析，以更好地了解共同决策及其与护理的联系 结果。由于创建了差异化的护理模式，以更有效地利用OPWH， 一个量身定制的战略，以及新的二元分析的贡献。公共卫生效益高，因为 * 新出现的需要是与OPWH一起进行干预，特别是在艾滋病毒发病率和 死亡率在上升。为确保与社区的兼容性，将与利益相关者分享调查结果 包括社区工作组（同行、临床医生）、资助者（PEPFAR、全球基金）和实施者 (MoH，非政府组织），以指导未来的I型混合，集群随机试验在乌克兰。

Among the 5.5 million older people with HIV (OPWH) over 50 years, 80% live in low and middle income countries (LMIC). Ukraine, an emblematic LMIC in Eastern Europe and Central Asia (EECA), is the only world region with increasing HIV incidence and mortality. Among the 240,000 PWH in Ukraine, OPWH account for 25% of people with HIV but <30% are linked to ART within 6 months of diagnosis, with substantial proportions dropping out-of- care (OOC) once on ART. Consequently, mortality is 3-11 times higher than the age-matched general population. Key barriers to ART engagement for OPWH include substance use disorder, depression, and HIV stigma. PEPFAR has prioritized OPWH as an intervention target since only 43% of women and 34% of men were receiving ART in 2019. OPWH in particular have been impacted by COVID-19. In May 2020, our phone survey of 123 OPWH revealed that 58% needed assistance with their HIV care. To achieve the 95-95-95 HIV targets by 2030, Ukraine needs effective strategies to (re-)engage and retain OPWH in ART. In line with emerging differentiated care models, peer navigation (PN) is an evidence-based strategy to link and re-engage OOC PWH, including ART. Our qualitative data in Ukraine suggest OPWH prefer peers over professionals to engage them in HIV care. Peer-navigation, however, has not yet been adapted and tailored for OPWH in resource-limited settings though lessons learned from COVID may guide its delivery. Moreover, PN has repeatedly been superior to treatment as usual (TAU), but the extent to which peer/client dyads effectively interact has not yet been explored. We intend to tailor PN for OPWH using ADAPT-ITT, an evidence-based adaptation strategy, to create PROST (Peer-Run Optimal Strategy for Treatment or “To your health” in Ukrainian), and pilot test it to (re- )engage OPWH in care and ART. We hypothesize that the tailored PROST will more effectively (re-)engage OPWH and increase ART uptake by overcoming unique barriers to care relative to TAU. During the pilot RCT 10 trained Peers will deliver PROST for 12 weeks to 60 OOC OPWH compared to 30 OOC OPWH receiving TAU. Randomization will be stratified by previous ART experience and participants will be followed for 6 months. Outcomes will include measures of acceptability, feasibility, and preliminary efficacy. Using survey items from baseline, week 12, and week 24 on trust, compatibility, and perceived quality of peer-client interactions, we will conduct dyadic analyses of peers and clients to better understand shared decision-making and linkage to care outcomes. Innovation is high due to creating a differentiated care model to more effectively engage OPWH using a tailored strategy as well as the contribution of the novel dyadic analysis. Public health benefit is high due to the emerging need to intervene with OPWH, especially in the only major region where HIV incidence and mortality is increasing. To ensure compatibility with the community, findings will be shared with stakeholders including a Community Working Group (peers, clinicians), funders (PEPFAR, Global Fund), and implementers (MoH, NGOs) to guide a future Type I Hybrid, cluster randomized trial in Ukraine.