Testing a Novel Data-to-Suppression (D2S) Intervention Strategy in the Ryan White HIV/AIDS Program
- Conditions
- Hiv
- Interventions
- Behavioral: Data to Suppression (D2S)
- Registration Number
- NCT05140421
- Lead Sponsor
- City University of New York
- Brief Summary
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 strategies and research focused on medical care (re-)linkage, the investigators propose to implement and rigorously evaluate the effectiveness of a novel 'data-to-suppression' (D2S) intervention among RWPA behavioral health and housing program clients who are 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.
- Detailed Description
The investigators will implement and evaluate the Data-to-Suppression (D2S) intervention in Aim 1, which applies a cluster-randomized, stepped-wedge design. Agencies eligible for the trial will be matched in pairs and then randomized within pairs to early (Period 1) or delayed (Period 2) D2S intervention implementation. Our design will also use baseline data from a 12-month pre-implementation period (Period 0), for which D2S reports will be retrospectively generated. Each period will include two rounds of report releases (six months apart), each with a 12-month look-back period. Period 2 will begin 12 months after the start of Period 1. In both arms, clients without viral suppression (VS) will be followed forward for viral load (VL) outcomes after report issue date. Outcomes data will be derived from the NYC HIV Surveillance Registry, a population-based data source of longitudinal laboratory (VL, CD4) testing records on all diagnosed NYC PWH, regardless of medical provider within NYC, and for periods extending before and after RWPA program enrollment or discontinuation.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 1619
- For each stepped-wedge implementation period (Period 0, 1, or 2), clients eligible for trial inclusion must have: (1) ≥1 viral load (VL) test in the report year (evidence that they are in HIV care in NYC); (2) unsuppressed VL (≥200 copies/mL) at last reported VL test during that year; and (3) a reported service in one of the eligible programs/agencies during the report year. In addition, they must still have an open RWPA enrollment in one of the eligible programs and agencies and be presumed living at the time of report generation (two months following the end of the report year on which data are being shared with providers).
- Agencies without current NYC RWPA funding for housing assistance or behavioral health (mental health, supportive counseling or harm reduction) services are excluded. Agencies with <5 clients meeting the above inclusion criteria over three recent pre-implementation sample periods of data are also excluded (due to insufficient numbers of unsuppressed clients). Clients enrolled in NYC RWPA behavioral health or housing programs are excluded from the trial if they are virally suppressed, deceased, or lacking any evidence of NYC HIV care for a full year at the time a D2S report is issued. Given the potential lag in reporting to surveillance and the need to use the freshest available surveillance data for D2S reports, some clients may later be found to have died or to have a VL<200 dated after their qualifying VL≥200 but prior to D2S report generation; such clients will be excluded post hoc from that round of follow-up due to VS at the time of intervention. Similarly, clients later reported (in programmatic data) to have been closed out of all eligible programs before the report issue date will be excluded post hoc.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description Early Implementation Data to Suppression (D2S) This arm will receive D2S intervention components during Period 1 (Early Implementation) as well as throughout Period 2 of the stepped-wedge trial. Delayed Implementation Data to Suppression (D2S) This arm will receive no D2S intervention components during Period 1 (Early Implementation), but will then receive all D2S intervention components in Period 2, starting 12 months later.
- Primary Outcome Measures
Name Time Method Timely viral suppression 6 months Registry-reported VL \<200 copies/mL on any VL test dated in the six months after the client first appeared as unsuppressed on a D2S report for the period
- Secondary Outcome Measures
Name Time Method Time to viral suppression 12 months Time to first VL \<200 copies/mL after client's first appearance on a D2S report for the period
Trial Locations
- Locations (27)
Housing Works
🇺🇸New York, New York, United States
Bridging Access to Care, Inc.
🇺🇸New York, New York, United States
Planned Parenthood of Greater New York
🇺🇸New York, New York, United States
Interfaith Medical Center
🇺🇸New York, New York, United States
New York Presbyterian Hospital
🇺🇸New York, New York, United States
Alliance for Positive Change
🇺🇸New York, New York, United States
Mount Sinai Beth Israel
🇺🇸New York, New York, United States
Exponents, Inc.
🇺🇸New York, New York, United States
African Services Committee, Inc.
🇺🇸New York, New York, United States
GMHC
🇺🇸New York, New York, United States
Harlem United
🇺🇸New York, New York, United States
Bailey House, Inc.
🇺🇸New York, New York, United States
New York Harm Reduction Educators, Inc.
🇺🇸New York, New York, United States
NYC Health and Hospitals Harlem
🇺🇸New York, New York, United States
BronxWorks, Inc.
🇺🇸New York, New York, United States
The Institute for Family Health
🇺🇸New York, New York, United States
Boom!Health
🇺🇸New York, New York, United States
Project Hospitality, Inc.
🇺🇸New York, New York, United States
Research Foundation of State University of New York
🇺🇸New York, New York, United States
La Nueva Esperanza, Inc.
🇺🇸New York, New York, United States
Tolentine Zeiser Community Life Center
🇺🇸New York, New York, United States
St. Ann's Corner of Harm Reduction
🇺🇸New York, New York, United States
NYC Health and Hospitals Woodhull
🇺🇸New York, New York, United States
After Hours Project
🇺🇸New York, New York, United States
CAMBA, Inc.
🇺🇸New York, New York, United States
AIDS Center of Queens County, Inc.
🇺🇸New York, New York, United States
NYC Health and Hospitals Queens
🇺🇸New York, New York, United States