Ending the HIV Epidemic: Peer-supported collaborative care for mental health and substance use disorder care integration into HIV care settings

结束艾滋病毒流行：同伴支持的心理健康协作护理和药物滥用障碍护理纳入艾滋病毒护理机构

• 批准号: 10400376
• 负责人: Oluwaseun Falade-Nwulia
• 金额: $ 2.11万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10400376
• 关键词: Adoption; Anti-Retroviral Agents; Award; Caring; Case Manager; Characteristics; Clinic; Clinical Data; Cost Analysis; Effectiveness; Epidemic; Evidence based treatment; Grain; Group Meetings; HIV; Hybrids; Internships; Intervention; Knowledge; Maintenance; Mediator of activation protein; Medication Management; Mental Health; Mental disorders; Methods; Modeling; Outcome; Parents; Patient Recruitments; Patients; Pharmaceutical Preparations; Primary Health Care; Process; Provider; Psychiatric therapeutic procedure; Psychiatry; Questionnaires; RNA; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Activity; Self Management; Services; Specialist; Structure; Substance Use Disorder; Supervision; Surveys; Time; Training Support; Viral; Viral Load result; addiction; care providers; collaborative care; cost; effectiveness implementation trial; evidence base; experience; implementation measures; implementation process; implementation strategy; improved; multidisciplinary; peer; peer support; randomized trial; screening; skills; substance use; treatment as usual; treatment program; trial comparing; undergraduate student

Project Abstract Despite the effectiveness of antiretroviral medications for HIV suppression, people with HIV who also have mental health and or substance use disorders suffer disparities in rates of HIV suppression and retention in HIV care. Evidence based treatment for mental health disorders (MHD) and substance use disorders (SUD), including use of medications and self-management support have been associated with improved engagement in HIV care. However, a key gap in many HIV care settings is an inability to consistently screen and provide treatment for MHD/SUD. Barriers include limited provider knowledge of, and comfort with, MHD/SUD screening and treatment; time constraints; and absence of support staff to facilitate linkage and retention in MHD/SUD care. We propose a Hybrid Type 1 implementation- effectiveness trial of an adapted collaborative care model with peer-specialists as care managers, to enhance screening and treatment for MHD/SUD with resultant improvement in rates of HIV viral suppression and care engagement in an HIV clinic setting. Collaborative care (CC), the use of a care manager/team to facilitate and coordinate integration of mental health and substance use services with primary care, is a well-established evidence-based model. We intend to adapt CC by training and supporting peer specialist to function as care managers. We will then rigorously evaluate peer-supported CC as a component of a multidisciplinary team including the HIV care provider and an addiction psychiatry consultant as an implementation strategy for MHD/SUD screening and treatment in a continuity HIV care practice. We will compare this peer-supported CC to usual care (UC) referral to psychiatric care or a SUD treatment program at the discretion of the primary care provider and evaluate the implementation process using the RE-AIM framework. Our specific aims are as follows Specific Aim 1: In a randomized trial, compare the proportion of patients with MHD/SUD with HIV suppression randomized to the collaborative care (CC) and the usual care (UC) referral strategy. We will randomize 400 patients 1:1 to CC versus UC and compare the proportion of patients with HIV suppression (defined as HIV RNA <200 copies/ml) at 12 months. Specific Aim 2: Characterize processes of CC implementation including reach, adoption, fidelity, and provider acceptability, maintenance over time, and costs associated with the approach. We propose a mixed methods approach to measure the implementation processes guided by the RE-AIM Framework. In sub Aim 2b, we will conduct a cost analysis for the peer-supported CC model. Specific Aim 3: Determine the mediators of the CC intervention on HIV viral load suppression and retention in care. We will utilize a structured questionnaire and clinical data to assess mediators of the CC intervention on HIV outcomes and qualitatively assess overall experiences with the peer supported CC model and explore if patient characteristics impact experience.

项目摘要 尽管抗逆转录病毒药物对艾滋病毒的抑制有效，但艾滋病毒患者也有 心理健康和药物使用障碍在抑制HIV和保留率的差异 艾滋病毒护理。基于证据的精神疾病治疗（MHD）和药物使用障碍（SUD）， 包括使用药物和自我管理支持与改善参与度有关 在艾滋病毒护理中。但是，许多艾滋病毒护理设置中的关键差距无法始终如一地筛选并提供 MHD/SUD的治疗。障碍包括有限的提供者对MHD/SUD筛查的了解和舒适感 和治疗；时间限制；缺乏支持人员来促进MHD/SUD的联系和保留 关心。我们提出了一项合作的合作协作护理的Hybrid 1型实施效率试验 以同伴特性主义者为护理经理的模型，以增强对MHD/SUD的筛查和治疗 在HIV诊所环境中，HIV病毒抑制和护理参与率的结果提高了。 协作护理（CC），使用护理经理/团队来促进和协调心理的整合 与初级保健的健康和药物使用服务是一个良好的循证模型。我们打算 通过培训和支持同伴专家作为护理经理来调整CC。然后我们将严格 评估同伴支持的CC作为多学科团队的组成部分，包括艾滋病毒护理提供者和 成瘾精神病学顾问作为MHD/SUD筛查和治疗的实施策略 连续性艾滋病毒护理实践。我们将将这个同伴支持的CC与通常的护理（UC）进行比较 护理或SUD治疗计划由初级保健提供者酌情评估 使用RE-AIM框架实施过程。我们的具体目标如下 特定目标1：在随机试验中，比较HIV的MHD/SUD患者的比例 随机抑制协作护理（CC）和通常的护理（UC）推荐策略。我们将 随机对400例患者1：1与CC与UC进行比较，并比较HIV抑制患者的比例 （定义为HIV RNA <200拷贝/mL）12个月。 特定目的2：表征CC实施过程，包括覆盖范围，采用，保真度和 提供者的可接受性，随着时间的推移维护以及与方法相关的成本。我们提出了一个 混合方法的方法来测量由RE-AIM框架指导的实施过程。在sub AIM 2B，我们将为同伴支持的CC模型进行成本分析。 特定目的3：确定CC干预hiv病毒负荷抑制和 保留护理。我们将利用结构化问卷和临床数据来评估CC的介体 干预艾滋病毒结果，并通过同伴支持的CC模型定性评估整体经验 并探索患者特征是否影响经验。