Investigating the impact of preference-concordant differentiated service delivery for HIV

背景艾滋病护理的差异化服务提供（DSD），一种更好地为临床和社会服务的方法 通过了一项旨在满足艾滋病毒感染者需求的政策，以改善对护理的坚持和保留。 目前的DSD计划包括四个不同的类别（设施内个人，设施外个人， 提供者管理的组、客户端管理的组）。到目前为止，研究表明，相对于 传统的抗逆转录病毒疗法2021年，世界卫生组织修订了其指南，将DSD扩展到 向所有艾滋病毒携带者提供更加个性化的艾滋病毒服务。目前，DSD个体化通常基于临床 人力资源的稳定性或可用性，而不是患者的偏好和需求。随着国家的扩张 基于偏好的个体化DSD可以改善健康结局和生活质量。K01 提供了一个独特的机会，以解决这些研究差距。 候选人概述。我的长期职业目标是成为一名独立调查员， 在低收入和中等收入国家，将以病人为中心纳入艾滋病毒携带者健康计划。 虽然我在流行病学、统计方法、离散选择实验和 优先评估，这个K 01奖将提供必要的额外培训和经验，是一个 独立调查员设计和评估以患者为中心的健康计划，以改善临床 艾滋病毒/艾滋病感染者的生活成果和质量，并为政策决策提供信息。 职业发展和培训计划。我的教育计划包括结构化的课程， 专业会议，定向阅读，以及一个有特定目标的研究项目，时间安排与 这些活动。我的导师团队包括国际专家，他们专门从事与我的工作相关的领域。 培训目标：Scott Braithwaite博士（决策科学和比较有效性），安娜伯什廷博士 （基于主体的数学建模），Carolyn Berry博士（定性研究），Elvin Geng博士（实施 科学）和Elizabeth Bukusi博士（在肯尼亚开展和传播研究）。 环境纽约大学医学院提供了一个特殊的环境进行拟议的研究， 获得额外的培训和指导，并成功地过渡到独立调查员。 研究战略。我的研究将评估偏好一致计划对患者的影响， 在肯尼亚西部使用前瞻性队列研究和数学建模的人口结果。 具体而言，该研究将：1）测量患者愿意在不同功能之间进行的权衡 以及这些偏好如何随患者特征而变化; 2）确定偏好如何- 一致的DSD计划影响保留，依从性和病毒载量抑制; 3）估计长期 健康影响和成本的偏好一致的DSD程序使用数学建模。

Background. Differentiated service delivery (DSD) for HIV care, an approach to better serve clinical and social needs among people living with HIV (PLWH), has been adopted to improve adherence and retention in care. The current DSD programs include four different categories (within-facility individual, out-of-facility individual, provider-managed group, client-managed group). Studies have so far shown mixed results of DSD relative to conventional ART delivery. In 2021, the World Health Organization revised its guideline to expand DSD to offer more individualized HIV services to all PLWH. Currently, DSD individualization is often based on clinical stability or availability of human resources, rather than patient preferences and needs. As countries expand DSD, preference-based individualization of DSD could improve health outcomes and quality of life. This K01 provides a unique opportunity to address these research gaps. Candidate Overview. My long-term career objective is to become an independent investigator who specializes in incorporating patient-centeredness into health programs for PLWH in low- and middle-income countries. While I have developed research skills in epidemiology, statistical methods, discrete choice experiments and preference assessment, this K01 award will provide the necessary additional training and experience to be an independent investigator in the design and evaluation of patient-centered health programs to improve clinical outcomes and quality of life among PLWH and inform policy decision-making. Career Development and Training Plan. My educational program includes structured coursework, professional conferences, directed readings, and a research project with specific aims timed to coincide with these activities. My mentorship team includes international experts who specialize in areas related to my training goals: Dr. Scott Braithwaite (decision science and comparative effectiveness), Dr. Anna Bershteyn (agent-based mathematical modeling), Dr Carolyn Berry (qualitative research), Dr. Elvin Geng (implementation science), and Dr. Elizabeth Bukusi (study execution and dissemination in Kenya). Environment. NYU School of Medicine provides an exceptional environment to conduct the proposed study, obtain additional training and mentorship, and successfully transition to an independent investigator. Research Strategy. My study will evaluate the impact of preference-concordant programs on patient and population outcomes using a prospective cohort study and mathematical modeling in western Kenya. Specifically, the study will: 1) measure the trade-offs that patients are willing to make among different features of DSD programs and how these preferences vary by patient characteristics; 2) determine how preference- concordant DSD programs impact retention, adherence, and viral load suppression; 3) estimate the long-term health impact and costs of preference-concordant DSD programs using mathematical modeling.