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

摘要 瑞安白色艾滋病毒/艾滋病计划是减少人们之间健康差距的重要平台 艾滋病毒感染者（PWH）和扩大循证战略，以加强艾滋病毒护理的连续性。我们提出 一项基于纽约瑞安白色A部分（RWPA）计划的实施科学研究，以告知 * 向低收入者提供长效注射抗逆转录病毒疗法和相关支助服务， 收入，主要是黑人和拉丁美洲人/PWH谁一直在努力与日常口服抗逆转录病毒疗法坚持。作为主要 由于生物医学的进步，不需要坚持每日给药，LAI ART可以大大增加机会 对于健康、生存和传播预防，特别是在面临复杂的病毒屏障的人群中， 负载抑制然而，优化LAI ART的公共卫生影响需要科学的实施 评估对LAI与每日口服方案的看法和偏好，确定支持服务， 适合促进LAI吸收和参与的交付机制，并解决提供者信念的作用 哪些患者可以选择LAI。如果没有这些基础，LAI ART可能主要 这一现象甚至加剧了艾滋病毒感染者之间的差距。拟建项目 旨在：（1）了解LAI与日常口服ART治疗的看法、障碍/促进因素和期望 选择，在RWPA医疗病例管理（MCM）患者，核心工作人员和处方的六个焦点组 （2）量化参与ART提供和支持战略的偏好和驱动因素， 包括LAI和每日口服ART的选择，通过200例患者和200例 提供者;和（3）选择和试点战略，以促进LAI ART的吸收，坚持和在现实世界中的影响 护理机构。及时形成对患者和供应商的看法和偏好的工作将是至关重要的， 成功，公平推出LAI ART。拟议的研究将产生有价值的见解的障碍， LAI ART参与为PWH设计的RWPA MCM计划的促进者，并记录了依从性 隔栏.具体而言，焦点小组和地区选举委员会将阐明如何（以及哪些）RWPA资助的服务（例如，为 患者评估、联合护理计划、健康教育、家访和陪同预约） 可以应用或调整以增强LAI ART结果。目标3试点测试和后续RCT将进一步 通过衡量实施和临床，为LAI ART提供战略改进和扩大提供信息 拟议项目产生的战略成果。通过与研究所的伙伴关系， 纽约市纽约城市大学实施科学与人口健康（ISPH） 卫生部和六个RWPA服务提供机构，产品从拟议的项目和后续行动 RCT将转化为地方艾滋病毒服务规划和实践改进，同时进行传播 通过同行评审的出版物、在科学会议上的发言， 张贴在纽约的ISPH设计/维护的结束流行病仪表板网站上。

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.