[R01] Innovations in Implementing Decentralized HIV Services in Peru
Ente: National Institute of Allergy and Infectious Diseases
Scadenza: 2028-06-30
Importo max: 508.835 EUR
Paese: US
Descrizione
Both Peru and the U.S. have similar HIV prevalence and HIV treatment cascades. Despite high
HIV diagnosis and antiretroviral therapy initiation in Peru, retention in care and viral suppression
remain suboptimal, because HIV services are concentrated in large specialty clinics that create
travel, time, stigma, and workforce barriers for patients and providers. These delivery failures are
directly relevant to the United States, where safety-net, Ryan White, community health center,
and rural or urban primary care systems face similar challenges sustaining long-term HIV care,
integrating specialty services into primary care, reducing patient burden, and achieving durable
viral suppression across all people with HIV. This study will test a solution-oriented, measurable
implementation strategy to decentralize HIV care from specialty HIV clinics to primary healthcare
centers using a hub-and-spoke model supported by NIATx workflow redesign and Project ECHO
clinical mentoring. The foreign-site design is scientifically justified because Peru’s Ministry of
Health has already mandated decentralization, Lima has high-volume specialty HIV clinics linked
to numerous primary care centers, and the system provides a real-world setting to assess
whether structured implementation support can safely shift stable HIV care into primary care at a
scale and pace that would be difficult to achieve in the United States alone.
First, we will use a Delphi process to define explicit, measurable criteria for patient transfer,
primary care initiation, and quality health indicators needed to monitor safe decentralized HIV
care.
Second, we will assess patient, clinician, and health-system barriers and facilitators using
precise, scientifically relevant descriptors and contextual measures, including clinic capacity,
workforce readiness, geographic access, stigma, and service-delivery burden, avoiding broad or
unfalsifiable explanations not directly tied to measured outcomes.
Third, using a stepped-wedge Type 2 hybrid implementation trial across four hub-and-spoke
regions, we will evaluate whether NIATx plus Project ECHO increases the proportion of people
with HIV receiving care in primary healthcare centers while improving retention in care, viral
suppression, adoption by clinics, fidelity to implementation procedures, and concordance with
decentralization guidelines.
This project advances NIH priorities by focusing on scientifically valid, measurable health
outcomes rather than descriptive disparities alone, and by actively testing, scaling, and
implementing evidence-based delivery strategies that can improve chronic HIV outcomes. The
results will provide practical tools, clinical criteria, workflow measures, and implementation
guidance that can be adapted by U.S. HIV programs seeking to bring care closer to patients,
reduce avoidable loss to follow-up, strengthen primary care capacity, and improve health
outcomes for Americans living with HIV in diverse service settings. The pr
Istituzione: YALE UNIVERSITY
PI: FREDERICK LEWIS ALTICE
Progetto: 5R01AI177082-04
Settori: National Institute of Allergy and Infectious Diseases
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