# A type 2 hybrid effectiveness-implementation trial to evaluate a population health combination intervention to meet HIV testing, linkage, and viral suppression goals in coastal Alabama

> **NIH NIH R01** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2023 · $900,317

## Abstract

Abstract
This proposal describes a 5-year research plan to adapt and evaluate implementation of three
evidence-based interventions to achieve the goals of Ending the HIV Epidemic (EHE) in Alabama (AL).
This combination intervention will (1) use novel big data approaches to inform precision public health
efforts to increase testing in priority populations, (2) decrease time to linkage to care, and (3) decrease
time to viral suppression (VS) among persons newly diagnosed with HIV in AL, a priority state in the
national EHE Initiative. The proposal leverages a dynamic and innovative collaboration of experienced
investigators from the University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR)
and the HIV Divisions of the state health department in AL (ADPH) and the Mobile County Health
Department (MCHD). The MCHD serves six predominantly rural counties in the southwestern region
of AL with low testing coverage, high incidence, and suboptimal times to linkage and VS for newly
diagnosed cases of HIV. We propose a type 2 hybrid implementation-effectiveness study guided by the
Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption,
Implementation, and Maintenance (RE-AIM) frameworks to adapt, implement, and evaluate three
Centers for Disease Control (CDC) evidence-based interventions: (1) a data-driven approach to direct
Community-based HIV testing in areas with low testing coverage, (2) Project Connect, to expedite
linkage at time of diagnosis and (3) a Rapid ART start program at MCHD community clinics in Alabama
(“COAST-AL”). In Aim 1, we will use qualitative methods to adapt COAST-AL combination intervention
to the local context. In Aim 2, we will deploy the adapted intervention across MCHD services areas
over 36 months. Our primary effectiveness outcome is days to VS after HIV diagnosis using state-level
surveillance data from ADPH. Our primary implementation outcome is proportion of zip code tabulation
areas with at least 15% of the adult population tested by 36 months compared to baseline using
surveillance and commercial HIV testing data sets. We will evaluate intervention acceptability,
feasibility, appropriateness from clients through in-depth interviews and with providers through surveys.
In Aim 3 we will conduct interviews with key stakeholders and work collaboratively with local and state
health department stakeholders to identify and prioritize implementation strategies that can be deployed
to sustain COAST-AL and facilitate its implementation in other public health jurisdictions across AL and
other rural EHE-prioritized states. Results of this research will lay the groundwork for a larger
implementation trial that will include rigorous evaluation of implementation strategies to integrate
COAST-AL into clinical and public health systems to meet EHE targets.

## Key facts

- **NIH application ID:** 10653984
- **Project number:** 5R01AI169671-02
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Lynn T Matthews
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $900,317
- **Award type:** 5
- **Project period:** 2022-07-01 → 2027-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10653984

## Citation

> US National Institutes of Health, RePORTER application 10653984, A type 2 hybrid effectiveness-implementation trial to evaluate a population health combination intervention to meet HIV testing, linkage, and viral suppression goals in coastal Alabama (5R01AI169671-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10653984. Licensed CC0.

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