Strengthening the Safety Net: Testing a Novel Data-to-Suppression (D2S) Intervention Strategy in the Ryan White HIV/AIDS Program

摘要 瑞安白色艾滋病毒/艾滋病计划（RWHAP）的低收入艾滋病毒感染者（PWH）是一个关键的资源， 减少艾滋病毒健康差距，扩大循证干预措施。由于RWHAP服务于超过50%的美国 PWH、RWHAP的成果对于实现“达到零”/终止艾滋病毒流行病（EHE）计划的目标至关重要。 作为向受艾滋病毒严重影响的县/市分发的RWHAP A部分（RWPA）资金的受赠者， 纽约市（NYC）在全市范围内及其RWPA方案中定期开展艾滋病毒护理连续监测， 提供支助服务，以减少护理/治疗的社会和行为障碍。本地数据一致 在接受艾滋病毒护理的RWPA客户中，病毒抑制（VS）低于接受艾滋病毒护理的非RWPA PWH。 相对于纽约市的艾滋病毒病例总数，纽约市RWPA客户（每年约14，000人）中黑人和拉丁美洲人占多数 PWH和高贫困社区。解决当地结果差异，填补数据到护理留下的空白 (D2C)战略和研究集中在医疗保健（重新）联系，我们建议实施和严格 评估一种新的“数据抑制”（D2 S）干预措施在约1,300名RWPA客户中的有效性， 艾滋病护理，但不抑制。基于对未受压制客户的监测的报告，加上D2 S能力建设 援助将指导RWPA提供者确定目标并提供循证战略，以改善VS。 我们提出的目标是：1）测量D2 S干预对及时VS和VS时间的影响，在一个逐步的- 楔形杂交1型试验; 2）通过比较D2 S应答的特征， D2 S暴露的客户，无论是否实现了VS，都要认识到定制和加强 3）评估D2 S的可接受性和参与者的偏好以及其实施的优先级， 八个（客户和供应商）焦点小组，并在离散选择实验（DCE）与RWPA工作人员（n=200）。 该提案响应了PAR-20-036中关于开展研究以加深对更广泛背景的理解的呼吁 通过利用广泛/多个数据集和资源，并应用实施科学， 方法来测试干预措施，以改善服务提供，并最终实现VS。这项研究还 与国家艾滋病毒/艾滋病战略目标保持一致，以减少健康差距-在这种情况下， RWPA的护理客户和同一司法管辖区内的其他PWH护理客户。拟议研究的混合1型试验 设计支持在纽约市以外迅速传播和吸收，如果干预措施被证明是有效的。通过 D2 S试验，D2 S响应驱动因素分析，以及NYC RWPA支持中的主要数据收集- 该项目旨在澄清未来对低收入、黑人和拉丁裔的干预方向， PWH，其护理连续性的进步对于实现90-90-90，“归零”和EHE计划目标至关重要。 鉴于COVID-19造成的不成比例的负担，该项目的潜在影响在COVID-19期间得到了加强。 19和农村妇女工作者保护局所服务社区的相关限制，以及持续护理/治疗的新障碍 以及在医疗和支持服务提供者之间就客户的需求保持密切沟通。

Abstract The Ryan White HIV/AIDS Program (RWHAP) for low-income people with HIV (PWH) is a key resource for reducing HIV health disparities and scaling up evidence-based interventions. As RWHAP serves >50% of US PWH, RWHAP outcomes are vital to achieving “getting to zero”/ Ending the HIV Epidemic (EHE) Plan targets. As a grantee for RWHAP Part A (RWPA) funding distributed to the counties/cities severely affected by HIV, New York City (NYC) conducts regular HIV care continuum monitoring citywide and in its RWPA programs, which offer support services to reduce social and behavioral barriers to care/treatment. Local data consistently show lower viral suppression (VS) among RWPA clients in HIV care than among non-RWPA PWH in HIV care. Relative to NYC HIV cases overall, NYC RWPA clients (~14,000 per year) over-represent Black and Latinx PWH and high-poverty neighborhoods. To address local outcome disparities and to fill gaps left by data-to-care (D2C) strategies and research focused on medical care (re-)linkage, we propose to implement and rigorously evaluate the effectiveness of a novel ‘data-to-suppression’ (D2S) intervention among ~1,300 RWPA clients in HIV care but unsuppressed. Surveillance-based reports on unsuppressed clients plus D2S capacity-building assistance will guide RWPA providers in targeting and delivering evidence-informed strategies to improve VS. Our proposed aims are to: 1) Measure D2S intervention effects on timely VS and time to VS, in a stepped- wedge hybrid Type 1 trial; 2) Identify modifiable determinants of D2S response, by comparing characteristics of D2S-exposed clients who do and do not achieve VS, to recognize opportunities to tailor and strengthen the intervention; 3) Assess D2S acceptability and participant preferences and priorities for its implementation, in eight (client and provider) focus groups and in a discrete choice experiment (DCE) with RWPA staff (n=200). This proposal answers the call in PAR-20-036 for research to deepen understanding of the broader context of VS, by leveraging extensive/multiple datasets and resources and applying implementation science methods to test an intervention to improve service delivery and ultimately achieve VS. The study is also aligned with the National HIV/AIDS Strategy goal to reduce health disparities – in this case, a VS gap between RWPA clients in care and other PWH in care in the same jurisdiction. The proposed study’s hybrid, Type 1 trial design supports rapid dissemination and uptake beyond NYC, should the intervention prove effective. Through the D2S trial, analysis of factors driving D2S response, and primary data collection in NYC RWPA support- service settings, the project seeks to clarify future intervention directions for low-income, Black and Latinx PWH, whose care continuum advances are vital for meeting 90-90-90, “getting to zero” and EHE Plan goals. The project’s potential impact is heightened in the time of COVID-19, given disproportionate burden of COVID- 19 and related restrictions in the communities RWPA serves, and new obstacles to continuity of care/treatment and to maintaining close communication between medical and support-service providers about clients’ needs.