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

在550万50岁以上的老年艾滋病毒携带者中，80%生活在低收入和中等收入国家 (LMIC)。乌克兰是东欧和中亚(EECA)的标志性LMIC，是世界上唯一拥有 艾滋病毒发病率和死亡率不断增加。在乌克兰24万威尔斯亲王医院中，OPWH医院占25%的人口 艾滋病毒携带者中有30%在确诊后6个月内与抗逆转录病毒治疗有关，其中相当大的比例下降到了 关爱(OOC)曾经是艺术。因此，死亡率是年龄匹配的普通人群的3-11倍。 OPWH参与抗逆转录病毒治疗的主要障碍包括物质使用障碍、抑郁和艾滋病毒污名。 PEPFAR将OPWH列为优先干预目标，因为只有43%的女性和34%的男性 2019年接受艺术。尤其是OPWH受到了新冠肺炎的影响。2020年5月，我们的电话调查 123个OPWH医院中有58%的人在护理艾滋病毒方面需要帮助。实现95-95-95艾滋病病毒的目标 到2030年，乌克兰需要有效的战略来(重新)参与和保留OPWH在ART方面的工作。与新兴市场保持一致 差异化护理模式，同行导航(PN)是一种基于证据的战略，以链接和重新参与OOC PWH， 包括艺术。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员来吸引他们 在爱滋病护理方面。然而，在资源有限的情况下，对等导航尚未被适应和定制为OPWH 然而，从COVID吸取的经验教训可能会指导其交付。此外，PN一再处于优势地位 到照常治疗(TAU)，但对等/客户端二元组有效交互的程度尚未达到 探索过了。我们打算使用Adapt-ITT，一种基于证据的适应策略，为OPWH定制PN，以创建 PROST(同行运行最佳治疗策略或乌克兰语中的“对您的健康”)，并对其进行试点测试(Re-Run )让OPWH参与护理和艺术。我们假设，定制的Prost将更有效地(重新)参与 通过克服与TAU相关的独特护理障碍，OPWH和增加抗逆转录病毒治疗的接受率。在试点RCT期间 10名训练有素的同行将向60名OOC OPWH提供为期12周的PROST，相比之下，30名OOC OPWH将接受为期12周的培训 陶先生。随机分组将根据以前的ART经验进行分层，参与者将被跟踪6个月。 结果将包括可接受性、可行性和初步效果的衡量标准。使用中的调查项目 关于信任、兼容性和感知的对等客户交互质量的基准、第12周和第24周，我们将 对同行和客户进行二元分析，以更好地了解共享决策和与护理的联系 结果。创新是因为创建了差异化护理模式，以便更有效地利用OPWH 一种量身定做的策略以及新颖的二元分析的贡献。公共健康收益很高，因为 新出现的需要对OPWH进行干预，特别是在艾滋病毒发病率和死亡率最高的唯一主要区域 死亡率正在上升。为确保与社区的兼容性，调查结果将与利益相关者共享 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 (卫生部，非政府组织)，以指导未来在乌克兰进行的I型杂交群组随机试验。

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.