The researchers will conduct a hybrid implementation-effectiveness study of a city-wide B-OK rollout led by PDPH with research and evaluation support from the University of Pennsylvania. The rollout uses a randomized stepped-wedge design across the 21 MCM sites that have not previously received B-OK. The four pilot sites that received bottles without structured training in late 2023 will now also receive the full package and be trained but be analyzed as a separate stratum given prior exposure. The evaluation is organized under RE-AIM, with implementation outcomes defined using Proctor's taxonomy and contextual determinants assessed using CFIR.
Study Type
OBSERVATIONAL
Enrollment
390
Medical case managers clients will receive a training on how to use B-OK bottles and will be given their own B-OK bottles. B-OK bottles are visual aids case managers can use explain how HIV treatment works in the body and to help clients visualize viral suppression. The bottles explain how HIV affects a person's health and how ART reduces viral load and eliminates HIV transmission risk.
HIV viral suppression
Binary, assigned to each client active at a participating site as of the end of each two-month (bimonthly) observation period. A client is classified as virally suppressed for a period if they had at least one viral load measured during the 6 months ending at the close of that period and the most recent such viral load was \<200 copies/mL; clients with no viral load measured during that 6-month window are classified as not suppressed. This is consistent with the PDPH surveillance definition of viral suppression and allows every active client to be classified in every period (baseline city average 74.4%).
Time frame: Every 6 months
Engagement in care
Binary; a viral load or CD4 count measured within the 6-month lookback window for the observation period.
Time frame: Every 6 months
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