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Principal Investigator: Mary Kathryn Irvine
Organization: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
Fiscal Year: 2024
Award: $592,950
Funding agency: National Institute of Mental Health
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.
Terms: <AIDS><AIDS Virus><AIDS/HIV><Achievement><Achievement Attainment><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Active Follow-up><Address><Adherence><Affect><Anti-Retroviral Agents><Automobile Driving><Behavioral><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><COVID burden><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 burden><COVID-19 crisis><COVID-19 disease burden><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health burden><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 related burden><COVID-19 years><CV-19><Caring><Characteristics><Cities><Client><Clinical><Communication><Communities><Continuity of Care><Continuity of Patient Care><Continuum of Care><Coronavirus Infectious Disease 2019><County><Data><Data Collection><Data Linkages><Decrease disparity><Decrease health disparities><Diagnosis><Economic Income><Economical Income><Enrollment><Epidemic><Evidence based intervention><Factor Analyses><Factor Analysis><Focus Groups><Funding><Future><Goals><Government><HIV><HIV Infections><HIV/AIDS><HRSA><HTLV-III Infections><HTLV-III-LAV Infections><Health><Health Resources and Services Administration><Health disparity mitigation><Health disparity reduction><Health system><Housing><Human Immunodeficiency Viruses><Human T-Lymphotropic Virus Type III Infections><Hybrids><Impoverished><Income><Intervention><Intervention Strategies><Interview><LAV-HTLV-III><Latine><Latinx><Latinx group><Latinx individual><Latinx people><Latinx population><Left><Light><Link><Low Income Population><Low income><Low income group><Lower disparity><Lower health disparities><Lymphadenopathy-Associated Virus><Maintenance><Measures><Medicaid><Medical><Methods><Mitigate health disparities><Modeling><Modification><Monitor><Neighborhoods><New York City><Outcome><Participant><Persons><Photoradiation><Position><Positioning Attribute><Poverty><Provider><Psychosocial Influences><Psychosocial Issues><RE-AIM><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Record Linkage Study><Reduce health disparities><Reporting><Research><Research Resources><Resources><Route><SARS-CoV-2 burden><SARS-CoV-2 disease burden><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 infection burden><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Service setting><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Shapes><Site><Testing><Time><Translations><Triage><Uninsured><United States Health Resources and Services Administration><Viral><Virus-HIV><active followup><anti-retroviral><antiretroviral therapy><antiretroviral treatment><assess effectiveness><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><behavioral health><care coordination><coordinating care><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><data resource><data sharing><design><designing><determine effectiveness><disparate effect><disparate impact><disparate result><disparity in health><disparity reduction><driving><effectiveness assessment><effectiveness evaluation><enroll><epidemic planning><epidemic preparedness><evaluate effectiveness><evidence base><examine effectiveness><experiment><experimental research><experimental study><experiments><follow up><follow-up><followed up><followup><health disparity><hybrid type 1 study><hybrid type 1 trial><hybrid type I study><hybrid type I trial><implementation measures><implementation outcomes><implementation research><implementation science><improved><incomes><inequitable effect><inequitable impact><inequitable outcome><intervention arm><intervention delivery><intervention effect><interventional strategy><low income individual><low income people><meeting><meetings><mitigate disparity><multiple data sets><multiple datasets><novel><obstacle to care><obstacle to healthcare><outcome disparities><outcome inequality><outcome inequity><outreach><patient navigator><post-COVID><post-COVID-19><post-coronavirus disease 2019><preference><programs><psychosocial><reach, efficacy, adoption, implementation, and maintenance><reduce disparity><reduction in disparity><research into practice><research to practice><response><safety net><scale up><service delivery><service programs><service providers><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social><stem><success><surveillance data><telehealth><therapy adherence><therapy compliance><translation><treatment arm><trial design><unequal effect><unequal impact><unequal outcome><uptake>