A Mixed Methods Assessment of Clinic Characteristics Associated with Successful Scale-up & Sustainment of Systems Navigation & Psychosocial Counseling for People Who Inject Drugs with HIV in Vietnam

摘要 在全球和越南，注射毒品(PWID)的人受到艾滋病毒流行的影响不成比例。 PWID的护理参与度显著低于PWID，并且经历了比 不注射毒品的艾滋病毒携带者。扩大艾滋病毒检测和治疗的努力在很大程度上未能 联系PWID，他们在护理方面遇到了独特的障碍。这些循证干预措施(EBI)甚至更少 已正常化(将干预措施纳入常规临床护理的过程)和 持续，造成时间和资源的重大损失。EBI的成功实施和 维持受到临床特征的影响，这可能成为重要的实施障碍或 促进者。然而，临床特征与EBI适合性、正常化和 人们对可持续发展知之甚少。建议的奖学金建立在申请者以前的背景基础上 为她的职业生涯做好准备，成为一名独立的混合方法研究员和实现科学家。这个 具体的奖学金目标是让申请者1)在开展与艾滋病毒有关的研究方面打下坚实的基础 实施科学研究；2)建立分析和解释方面的高级量化分析技能 统计模型；3)扩展她在进行混合方法研究和分析方面的专长；4)深化 她展示研究成果的技巧和英勇无畏。这些目标将通过以下方式实现 课程作业，赞助商和指导团队的指导，以及拟议研究的执行 项目。拟议的混合方法研究将在NIDA资助的更大范围内完成 在越南10个省的42个艾滋病毒检测点进行的整群随机实施试验(扩大HPTN 074：越南用于PWID抗逆转录病毒治疗的EBI的整群随机实施试验， 5R01DA047876-02)。这项研究将确定关键的临床特征，以扩大和维持 系统导航和心理社会咨询(SNAP)在越南的EBI，并检查如何适应 干预策略和实施策略都会影响Snap的持续。目标1将使用定性 与PWID参与者(n=36)和诊所工作人员(n=24-36)进行访谈，以基线收集调查数据 和Endline，以及与美国和越南的改进的Delphi方法(以改进放大测量) 艾滋病毒和实施科学方面的专家，以确定影响SNAP临床推广成功的因素。目标 2将使用42个地点的诊所工作人员调查来评估Snap和诊所水平因素的可持续性 与维持联系在一起。目标3将对诊所工作人员和主任进行24-36次定性采访，以 确定干预和实施策略适应和临床特征如何影响Snap 正常化和维持化。这项拟议的研究符合NIDA的目标，即将研究与 实践差距，为越南卫生部提供循证指导，以优化规模- 建立和维持Snap，这有可能在全球范围内增加携带艾滋病毒的PWID的福祉。

ABSTRACT Globally and in Vietnam, people who inject drugs (PWID) are disproportionately impacted by the HIV epidemic. PWID have considerably lower levels of care engagement and experience worse HIV outcomes than individuals with HIV who do not inject drugs. Efforts to scale-up HIV testing and treatment have largely failed to reach PWID, who experience unique barriers to care. Even fewer of these evidence-based interventions (EBIs) have been normalized (the process by which an intervention is integrated into routine clinic care) and sustained, resulting in significant losses of time and resources. The success of EBI implementation and sustainment is affected by clinic characteristics, which can act as important implementation barriers or facilitators. However, the ways in which clinic characteristics are related to EBI fit, normalization, and sustainment are poorly understood. The proposed fellowship builds on the applicant’s prior background to prepare her for a career as an independent mixed methods researcher and implementation scientist. The specific fellowship goals are for the applicant to 1) develop a strong foundation in conducting HIV-related implementation science research; 2) build advanced quantitative analysis skills in analyzing and interpreting statistical models; 3) expand her expertise in conducting mixed methods research and analysis; and 4) deepen her skills in presenting research findings and grantsmanship. These goals will be accomplished through coursework, mentorship from the sponsor and mentorship team, and execution of the proposed research project. The proposed mixed methods research will be completed within the context of a larger NIDA-funded cluster randomized implementation trial with 42 HIV testing sites in 10 provinces in Vietnam (Scaling up HPTN 074: a Cluster Randomized Implementation Trial of an EBI for Antiretroviral Therapy for PWID in Vietnam, 5R01DA047876-02). This study will identify key clinic characteristics for scale-up and sustainment of the systems navigation and psychosocial counseling (SNaP) EBI in Vietnam, and examine how adaptations to both the intervention and implementation strategies influence sustainment of SNaP. Aim 1 will use qualitative interviews conducted with participant PWID (n=36) and clinic staff (n=24-36), survey data collected at baseline and endline, and the modified Delphi method (to improve scale-up measurement) with US and Vietnamese experts in HIV and implementation science to identify factors influencing clinic scale-up success of SNaP. Aim 2 will use clinic staff surveys across the 42 sites to evaluate sustainment of SNaP and clinic-level factors associated with sustainment. Aim 3 will involve 24-36 qualitative interviews with clinic staff and directors to determine how intervention and implementation strategy adaptations and clinic characteristics influence SNaP normalization and sustainment. The proposed research aligns with NIDA’s goals of bridging the research-to- practice gap by providing evidence-informed guidance to Ministries of Health in Vietnam for optimizing scale- up and sustainment of SNaP, which has the potential to increase wellbeing for PWID with HIV globally.