To enhance the uptake of efficacious interventions

Post date: Apr 6, 2015 11:48:40 PM

Research Objectives and Scope

To meet these aims, research is needed to address the following goals. The listed research questions are considered high priority in order to increase the public health impact of interventions in these domains, but this is not an exclusive list of potential important research directions.

To enhance the uptake of efficacious interventions, the following types of studies are encouraged:

1. Dissemination research

Studies of systemic interventions to influence organizational structure, climate, and culture, in order to promote organizational readiness and capacity for intervention dissemination, adoption, and implementation with fidelity and effectiveness.

Studies to understand, implement, and evaluate technological innovations (including media) in order to enhance the scalability of interventions.

Studies to understand and promote the dissemination and uptake of proven biomedical HIV prevention interventions by individuals, providers on HIV incidence and transmission rates.

2. Cost-effectiveness, modeling, and economic evaluations

Model and conduct cost assessments of interventions and approaches to promote HIV-testing, prevention, and treatment.

Identify resource allocation strategies that optimize intervention impact for providers, and health care systems.

3. Synthesize research to inform public health decision-making

Research syntheses to identify key intervention targets and promising intervention strategies across the HIV care continuum (e.g., diagnosing HIV-infected individuals, linking them to primary HIV care, initiating antiretroviral medications when indicated, maintaining antiretroviral adherence, and long-term retention in care).

Analyses of existing data to inform future research directions and potential interventions for implementation in the area of social determinants of health. In particular, to elucidate the most influential determinants and interventions for most at risk populations.

4. Research to strengthen personnel and health systems

Studies to assess the efficiency and effectiveness of alternative staffing approaches in treatment settings, including task shifting, task-sharing, and involvement of informal health care providers

Studies to understand the benefit of varying training methodologies (e.g., didactic training, clerkship, on-site mentoring, on-going consultation, internet-based courses) to prepare providers to offer HIV prevention, treatment, and adherence services.

Studies to develop and test better intervention approaches that integrate HIV prevention and care with more comprehensive responses to social service needs.

To enhance the effectiveness and efficiency of evidence-based interventions (EBIs), the following types of studies are encouraged:

1. Implementation science and operations research

Studies to identify specific factors affecting the successful implementation of currently available EBIs, and studies to develop, implement, and evaluate strategies to enhance the effectiveness of EBIs for HIV prevention and treatment in real-world community and clinical settings.

Studies to improve measurement of and interventions to enhance fidelity to efficacious interventions.

Studies to evaluate optimal approaches to integrate community care delivery to include HIV prevention, care, and treatment with related services (sexually transmitted infections, family planning, prenatal care, malaria, tuberculosis).

Studies to identify and evaluate existing practices within HIV care that hold promise for sustaining patient engagement in care and treatment adherence and persistence.

Studies focused on factors that influence the sustainability of EBIs for HIV prevention and treatment, and interventions to improve long-term sustainability.

Studies to understand causal pathways and synergies and antagonism among potential combination intervention components that have previously demonstrated efficacy; this would include implementation/programs offering components, whether in combination at one site or multiple programs with separate individual components offered to the same population

Studies to determine which prevention interventions have the highest and lowest levels of acceptability and adherence in different populations and settings at high risk of HIV infection, and to evaluate interventions to increase acceptability and adherence

2. Comparative effectiveness

Research to determine the optimum timing and intensity of intervention for those individuals newly diagnosed in order to ensure risk reduction, linkage to care and /or treatment initiation, and comparative effectiveness research on proven strategies for HIV treatment adherence.

Comparative effectiveness studies that determine the most effective and cost-effective integrated care models for co-occurring disorders with HIV infection.

3. Studies to analyze the impact of policy changes on public health outcomes

Studies to examine the impact of changes in policy/legislation that affect delivery of HIV/AIDS-related services and treatment.

Studies to determine the impact of new payment mechanisms, including the cost-effectiveness of alternative treatments, services or structures for provision of services.

Studies to identify, describe, or track individual, family, provider, organizational or systems-level outcomes resulting from changes in services or benefits.

The R21 mechanism is specifically intended to encourage new exploratory and developmental research projects. These studies should break new ground or extend previous discoveries toward new directions or applications. These studies may involve considerable risk but may lead to a breakthrough in a particular area, or to the development of novel methodologies, tools, technologies, or interventions that could have a major impact on health research and practice. Unlike applications under the R01 mechanism, preliminary data are not required for R21 applications. Preliminary data may nonetheless be included if available.