Implementation Research on Telehealth Strategies to Support Retention in Care and Treatment among Antiretroviral Therapy (ART) Patients and Pre-exposure Prophylaxis (PrEP) Clients

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The purpose of this notice of funding opportunity (NOFO) is to solicit research applications to evaluate the effectiveness of telemedicine to improve adherence to HIV prevention and treatment medication while also exploring the “implementability” of its practice into routine care. Specifically, this NOFO will, via a hybrid effectiveness-implementation research design: 1) evaluate the effectiveness of telemedicine and supportive strategies to allow for retention in care and maintenance of antiretroviral therapy (ART) medication adherence among clinically stable people with HIV (PWH) and pre-exposure prophylaxis (PrEP) medication adherence among those at risk for HIV infection, especially among racial/ethnic minorities, men who have sex with men (MSM), and transgender women and 2) identify potential implementation challenges by evaluating the delivery of these strategies. Projects should evaluate the cost-effectiveness of providing differentiated service delivery (DSD) options that include telemedicine to patients on ART or on PrEP. DSD is a recommended approach to service delivery that simplifies and/or adapts HIV prevention and treatment services to more effectively and efficiently serve the needs of people living with, and at risk of acquiring, HIV while reducing unnecessary burdens on the healthcare system. The goals of the research are: 1) to evaluate three recommended strategies for DSD for clinically stable patients (a. telehealth appointments for PrEP and ART with multi-month prescription refills; b. biospecimen sample self-collection for routine screenings; and c. supplemental support delivered by specialized staff such as community health workers or patient navigators); 2) to determine which strategy or combination of strategies is associated with retention in care, medication adherence, viral suppression and prevention of HIV infection, and costs to implement each approach; 3) to evaluate the cost effectiveness of implementing these strategies in comparison to the standard, in-person clinical visit model of care; and 4) to identify potential challenges to implementation and determine the acceptability, feasibility and sustainability of implementing these strategies into routine practice. Ultimately, this NOFO aims to support research to identify, via cost analysis, process and outcome evaluation and patient and provider feedback, which elements of implementation provide the most impact for the least cost to patients, providers, and clinics.

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