Adaptation, execution, and evaluation of a differentiated service delivery model for PMTCT

项目摘要/摘要 全球每年约有140万名孕妇受到艾滋病毒的影响。在东部和南部 非洲，近三分之一的艾滋病毒携带者在怀孕期间接受抗逆转录病毒治疗后失去了随访机会(LTFU) 29%-42%的人在产后不会保持病毒抑制。差异化服务交付(DSD)是 世界卫生组织认可的循证实施战略，以改善留存 以及对艾滋病毒携带者的病毒抑制。渠务署简化及调整爱滋病病毒服务以切合需要 和临床稳定客户的偏好，允许加强向不稳定客户提供服务，这些客户 最需要帮助的人。然而，预防艾滋病毒母婴传播(PMTCT)的DSD模型有 缺乏并缺乏指导DSD适应防止母婴传播的数据。这项K23研究的目标是 调整、执行和评估PMTCT的DSD模型，以增强保留和病毒抑制 人口。中心假设是，滞留和病毒抑制是由一种复杂的相互作用驱动的 个人和背景因素以不同的方式影响妇女，并塑造她们对服务的偏好。 在资源有限的情况下，预防母婴传播方案可以通过为更多的人提供服务来改善结果 使用DSD方法准确、高效地满足客户的需求和偏好。具体目标是： (1)通过对孕妇和孕妇的离散选择试验，确定患者对预防母婴传播服务的偏好 产后感染艾滋病毒的妇女留在护理或LTFU，并使用这些数据来识别 DSD模型的组成部分；(2)为预防母婴传播开发DSD模型，并建立组织准备情况 实施，采用以人为本的设计方法，纳入利益攸关方的观点；(3) 在资源有限的情况下，在一家妇幼保健诊所执行预防母婴传播的DSD模型，以及 使用RE-AIM/PRISM框架评估模型的实施。这项研究将在 肯尼亚提供医疗服务的学术模式(AMPATH)，并利用 东非国际艾滋病流行病学数据库评估联合会(EA-IeDEA)。除了……之外 发展新知识，这个K23奖项将支持私家侦探约翰博士的职业发展和培训 汉弗莱，这样他才能实现他的职业目标。他的职业目标是成为一名独立调查员 具有在资源有限的情况下改善艾滋病毒成果的执行战略方面的专门知识，并具有 特别关注防止母婴传播。他的培训目标是：(1)设计优化的实施策略，使用 离散选择方法论和整合多方法研究产生的数据；(2)执行 以及使用实施框架评估实施战略。这个K23将提供一个证据- 基于预防母婴传播的DSD模型，填补了针对这一人群的指南和文献中的一个主要空白。这个K23 还将让Humphrey博士开发R01，以在#年进行PMTCT的DSD模型的大规模试验 EA-IeDEA网络作为独立调查者。

Project Summary/Abstract Globally, approximately 1.4 million pregnancies are impacted by HIV every year. In Eastern and Southern Africa, nearly a third of women living with HIV initiating ART during pregnancy become lost to follow-up (LTFU) and 29-42% do not maintain viral suppression in the postpartum period. Differentiated service delivery (DSD) is an evidence-based implementation strategy endorsed by the World Health Organization to improve retention and viral suppression for people living with HIV. DSD simplifies and adapts HIV services to meet the needs and preferences of clinically stable clients, allowing for intensification of service delivery to unstable clients who are most in need. However, DSD models for prevention of mother to child transmission of HIV (PMTCT) are lacking and data to guide the adaptation of DSD to PMTCT are scarce. The objective of this K23 research is to adapt, execute and evaluate a DSD model for PMTCT to enhance retention and viral suppression for this population. The central hypothesis is that retention and viral suppression are driven by a complex interplay of individual and contextual factors that affect women differently and shape their preferences for services. PMTCT programs in resource-limited settings can improve outcomes by tailoring service delivery to more accurately and efficiently meet clients’ needs and preferences using a DSD approach. The specific aims are: (1) Determine patient preferences for PMTCT services through a discrete choice experiment with pregnant and postpartum women living with HIV who are retained in care or LTFU, and use these data to identify components for the DSD model; (2) Develop a DSD model for PMTCT and build organizational readiness for implementation, using a human-centered design approach that incorporates stakeholders’ perspectives; (3) Execute a DSD model for PMTCT at one maternal and child health clinic in a resource-limited setting, and evaluate the model’s implementation using the RE-AIM/PRISM framework. This research will take place at the Academic Model Providing Access to Healthcare (AMPATH) in Kenya and utilize the research infrastructure of the East Africa International Epidemiology Databases to Evaluate AIDS (EA-IeDEA) Consortium. In addition to developing new knowledge, this K23 award will support the career development and training of the PI, Dr. John Humphrey, so that he can achieve his career goal. His career goal is to become an independent investigator with expertise in implementation strategies to improve HIV outcomes in resource-limited settings, with a specific focus on PMTCT. His training aims are: (1) Designing optimized implementation strategies using discrete choice methodology and integrating data generated through multi-methods research; (2) Executing and evaluating implementation strategies using implementation frameworks. This K23 will yield an evidence- based DSD model for PMTCT, filling a major gap in the guidelines and literature for this population. This K23 will also position Dr. Humphrey to develop an R01 to conduct a large-scale trial of a DSD model for PMTCT in the EA-IeDEA network as an independent investigator.