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Publication Profiles

Increasing antiretroviral therapy adherence and retention in care among adults living with HIV in Philadelphia: a study protocol for a stepped-wedge cluster-randomised type 2 hybrid effectiveness-implementation trial of managed problem-solving plus (MAPS+

Citation

Van Pelt AE, Bilker WB, Nkwihorez H, et al. Increasing antiretroviral therapy adherence and retention in care among adults living with HIV in Philadelphia: a study protocol for a stepped-wedge cluster-randomised type 2 hybrid effectiveness-implementation trial of managed problem-solving plus (MAPS+) delivered by community health workers. BMJ Open. 2023;13(10):e079585. doi:10.1136/bmjopen-2023-079585

Implementation stage:

Implementation

Implementation outcomes reported:

Cost, Penetration, Sustainability

Continuum target addressed:

ART adherence, Viral suppression, Engagement in treatment (including retention and re-engagement)

Geography:

Philadelphia County-PA

Study Participant Classification:

Recipients of care, Providers

Plain Language Objectives

The researchers planned a trial across 10 Philadelphia clinics to test whether a community health worker program improves HIV medication use and retention in care, while also studying cost, reach, implementation, and long-term use.

Plain Language Abstract

Philadelphia needs practical ways to help people with HIV take treatment and remain in care. Managed Problem Solving Plus, or MAPS+, adapts an existing problem-solving program by adding care-retention support and delivery by community health workers. This protocol describes a stepped-wedge cluster-randomized trial in 10 clinics, meaning clinics would begin the program at different assigned times. Researchers planned to evaluate viral suppression and retention one year after implementation among 390 participants. They would also study whether a menu of implementation strategies affected reach and cost and examine mechanisms and long-term sustainment with 56 participants. The protocol notes modifications related to COVID-19 and other factors. Ethical oversight and safety monitoring procedures were established. Because this publication describes a protocol, it contains no trial effectiveness or implementation results and should not be interpreted as showing that MAPS+ works. The study was designed to produce both clinical and implementation evidence relevant to MAPS+ and other behavioral programs supporting HIV medication adherence and retention.

Key Takeaways

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