# Managed Problem Solving for ART Adherence and HIV Care Retention Delivered by Community Health Workers: A Stepped Wedge Hybrid Type II Effectiveness Implementation Trial

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $794,441

## Abstract

Project Summary/Abstract
To achieve aspirational goals to end the HIV epidemic (EHE), evidence-based practices (EBPs) to increase viral
suppression must be implemented effectively nationally. The Managed Problem Solving (MAPS) behavioral
intervention is an EBP for behavior change in people living with HIV (PLWH). To accomplish the goals of this
application, we leverage a data-to-care partnership between the Philadelphia Department of Public Health
(PDPH) and participating clinics (n = 12), which enhances the sustainability of our approach. We propose that
MAPS can be delivered by trained Community Health Workers (CHWs). The use of CHWs to deliver MAPS is
justified by their ability to develop trusting relationships with their clients and the need for task shifting in busy
clinics. In order to also address retention in care, we will adapt MAPS to also focus on problem solving activities
tailored toward retention in care (now termed MAPS+). CHWs will be located in clinics to implement MAPS+ to
improve viral suppression and care retention in PLWH. Data-to-care allows for identification of people who are
lost to care and link these patients back to care. Currently, medication adherence and retention in HIV care are
not targeted in data-to-care so we will build on this approach to facilitate the identification of PLWH who are out
of care and not virally suppressed to offer them MAPS+. Our set of implementation strategies include task-
shifting the delivery of MAPS+ to CHWs, providing the CHWs training and ongoing support, and increasing
communication between the CHWs and medical care team via standardized protocols. We will conduct a hybrid
type II effectiveness-implementation trial with a stepped-wedge cluster randomized design in 12 clinics to test
MAPS+ compared to usual care using a set of implementation strategies that we believe will best support
implementation. Each clinic will be randomized to one of three implementation start times. We will collect baseline
(usual care) data from each clinic for 6 months, followed by MAPS+ and our package of implementation
strategies for 12 months, in three cohorts of 4 clinics each. Aim 1 will test the effectiveness of MAPS+ on clinical
effectiveness outcomes, including viral suppression (primary) and retention (secondary). Aim 2 will examine the
effect of the package of implementation strategies on reach. We will also measure implementation cost. Aim 3
will apply a qualitative approach to understand processes, mechanisms, and sustainment of our implementation
approach. Our results will guide future efforts to implement behavioral EBPs across the HIV care continuum,
consistent with the “treat” pillar of EHE, and move the science of implementation services, consistent with NIH
strategic priorities.

## Key facts

- **NIH application ID:** 10269940
- **Project number:** 5R01NR019753-02
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Rinad Sary Beidas
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $794,441
- **Award type:** 5
- **Project period:** 2020-09-25 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10269940

## Citation

> US National Institutes of Health, RePORTER application 10269940, Managed Problem Solving for ART Adherence and HIV Care Retention Delivered by Community Health Workers: A Stepped Wedge Hybrid Type II Effectiveness Implementation Trial (5R01NR019753-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10269940. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*