Sequential strategies to reach and reengage individuals after lapses from HIV care in zambia
Active Project Grant Awarded Last action
- Award ID
- R01MH135819
- Recipient
-
The Washington University UEI L6NFUM28LQM5
- Awarding agency
-
National Institute of Mental Health
National Institutes of Health, Department of Health and Human Services
- Obligated
- $2,102,746
Award facts
- Assistance listing
- 93.242 Mental Health Research Grants
- Completion date 47% complete
- Place of performance
- St. Louis, MO 63110, USA
Award details come from USAspending.gov.
Description
- Abstract
- Treatment lapses remain one of the most enduring challenges to viral suppression in africa. These individuals have higher rates of viremia (~70%), morbidity, and mortality, and now represent the majority of those hospitalized with advanced HIV. Even among those who return to care, 30-50% have repeat lapses due to ongoing challenges with care such competing obligations, travel/mobility, clinic-based, or psychosocial barriers. Effective strategies for durably reengaging individuals with treatment lapses must address two steps: they must first be brought back into care, but after return, person-centered strategies are needed to prevent repeat lapses and keep them reengaged long-term. Navigation (NAV) and community-based medication delivery (CB-MED) are strategies that have been found to improve outcomes among those newly initiating or stable on art, and our preliminary data indicates their complementary mechanisms hold promise to address key challenges at both the return and reengage stages. NAV offers a flexible approach to tailor outreach, care coordination, and psychosocial support to match individuals' unique barriers to care. Leveraging navigators to provide ongoing CB-MED efficiently adds instrumental support to further reduce challenges with medication access. Still, rigorous evidence on the use, timing, and optimal combinations of NAV and CB-MED after treatment lapses is lacking. For example, offering NAV+CB-MED may improve rates of art RE-initiation, but this may not translate to better longer-term outcomes if IT is stopped after return and individuals then receive the same care that previously failed. We propose a sequential multiple assignment randomized trial (SMART) among 1270 individuals who are >30 days late for an appointment to assess different sequential combinations of return to care and reengagement strategies. We randomize participants in the first-stage to receive (1) routine phone outreach only (standard of care [SOC]) or (2) NAV+CB-MED for rapid art RE-initiation in the community and reentry support. Among those who return to care, we RE-randomize them in the second-stage to: (1) routine care and counseling after return (RCC [SOC]), (2) NAV only after return, or (3) NAV+CB-MED after return. In aim 1A, we compare phone outreach only VS. NAV+CB-MED on time to art RE-initiation and return to care. In aim 1B, among individuals who return, we compare RCC, NAV alone, and NAV+CB-MED on retention in care after return (time to missing a pharmacy refill by >14 days). In aim 2, we assess the overall effectiveness and cost-effectiveness of the six sequential combination return-and-reengage strategies embedded within the SMART design on viral suppression at 18- months after initial randomization (primary outcome). Lastly, in aim 3 we conduct a mixed-methods evaluation to understand implementation (e.g., reach, adoption, fidelity, acceptability), mechanisms of action, and potential for sustainability among diverse stakeholders (e.g., participants, health care workers, public health officials). This proposal advances a high-priority research agenda to identify the most effective and efficient combination strategies to both return individuals with treatment lapses to care and then keep them reengaged.
Transactions
| Action | Obligated | Date |
|---|---|---|
| Amendment | $138,382 | |
| Amendment | $0 | |
| Amendment | $26,959 | |
| Amendment | $298,297 | |
| Amendment | $313,900 | |
| Amendment | $0 | |
| Amendment | $0 | |
| Amendment | $662,604 | |
| Original award | $662,604 |
Subawards
| Subrecipient | Amount | Awarded |
|---|---|---|
| Seoul National University | $26,959 | |
| Centre For Infectious Disease Research In Zambia | $298,297 | |
| Centre For Infectious Disease Research In Zambia | $300,000 | |
| Seoul National University | $27,097 | |
| The Johns Hopkins University | $27,838 |
Quick answers
Who received award R01MH135819?
R01MH135819 was awarded to The Washington University by National Institute of Mental Health (National Institutes of Health) on August 9, 2024.
How much is award R01MH135819 worth?
$2,102,746 has been obligated on R01MH135819.
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