A person-centred Needs Informed model of Care for people with HIV (NICHE), to improve wellbeing, mental health and reduce socio-economic disadvantages and stigma.

Aims: To improve mental and physical wellbeing in people living with HIV (PLWH), mitigating the effects of social and economic disadvantage and stigma, through developing and evaluating a needs-based model of care with a health coaching and social prescribing intervention. Background: HIV is now a treatable chronic condition with near-normal life expectancy, often requiring only annual specialist monitoring. However, a unique and interlinked set of adverse psychosocial factors including high levels of depression, stigma and socioeconomic disadvantage impact considerably on wellbeing and use of specialist services. A new model of care could better address these issues while being cost-saving or cost-neutral for the NHS. The NHS long term plan lays out a fundamental shift in how the health services works, with increased emphasis on personalised care to improve health and wellbeing, and reduce reliance on clinical services. However, evidence lags behind policy, with significant methodological shortcomings in existing studies, and no UK studies in PLWH, Research plan: This 5-year programme will be delivered through six work packages (WP): WP1 (Year 1-2) We will update a systematic review of psychosocial interventions in PLWH (Study 1.1). We will conduct a nationally representative survey of PLWH to measure psychosocial and health-related factors (mental and physical health and wellbeing; social support; socioeconomic situation; stigma; health service usage) and assess evidence for causal pathways to inform intervention development (Study 1.2). Using qualitative methods, we will explore unmet needs among PLWH and optimal delivery of the intervention. (Study 1.3). We will use a Discrete Choice Experiment (Study 1.4) to elicit preferences for intervention delivery. WP2 (Year 2). Using evidence from WP1 we will co-design, with PLWH and other stakeholders, an intervention based on two principal components of personalised care: health coaching and social prescribing. (Study 2.1). We will also undertake development work for WP3 (Study 2.2). WP3 (Year 2-4). A Randomised Controlled Trial (RCT) will assess whether the intervention designed in WP2 improves health and wellbeing (primary outcome: Positive Outcomes HIV tool) and depressive symptoms (key secondary outcome: PHQ-9), for PLWH with significant needs, identified by clinic-wide psychosocial assessment. A linked observational cohort will assess changes in health and wellbeing over time. (Study 3.1). In-depth process evaluation using quantitative and qualitative methodologies will explore operationalisation (Study 3.2) and experience of the intervention (Study 3.3). WP4 (Year 5) A cost-effectiveness analysis will assess value for money from NHS and other perspectives (Study 4.1) WP5 (Year 5) will appraise the potential to adapt the intervention to other secondary care populations. WP6:(Years 2-5) will undertake dissemination, translational and transferability work with commissioners to enable translation of findings into policy and practice. Impact: This programme aims to improve health and wellbeing for PLWH, reducing inequalities and use of NHS resources PPI: Community demand and discussions with PLWH have driven this proposal. We have strong PPI input including a co-applicant. Patients, public and community HIV groups will be involved in design, delivery and dissemination. Dissemination: Our multi-format dissemination strategy will enable translation of findings into practice.