Implementing Integrated Services for People With HIV and Opioid Use Disorder

为艾滋病毒和阿片类药物使用障碍患者实施综合服务

• 批准号: 10596103
• 负责人: Amesika Nyaku
• 金额: $ 21.1万
• 依托单位: RUTGERS BIOMEDICAL AND HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10596103
• 关键词: AIDS prevention; Action Research; Address; Administrator; Adopted; Adoption; Aftercare; Area; Biometry; Caring; Clinic; Cluster randomized trial; Communicable Diseases; Communities; County; Elements; Epidemic; Evaluation; Evidence based practice; Funding; Goals; Government; HIV; HIV/HCV; Health; Health Services; Health Services Accessibility; Health Services Research; Hepatitis C Transmission; Hepatitis C virus; Infection; Injections; International; Knowledge; Learning; Measurable; Medicine; Mentors; Mentorship; Meta-Analysis; Methadone; Methods; Modeling; National Institute of Drug Abuse; New Jersey; Opioid; Outcome; Patient Care; Patients; Persons; Physicians; Positioning Attribute; Prevention; Provider; Recommendation; Reporting; Research; Research Personnel; Research Project Grants; Scientist; Services; Site; Source; Substance Use Disorder; Training; Training Programs; Translating; Use Effectiveness; Work; addiction; antiretroviral therapy; care systems; cluster randomized design; contextual factors; design; educational atmosphere; effectiveness evaluation; epidemic preparedness; evidence base; experience; health care delivery; health care quality; implementation framework; implementation outcomes; implementation science; implementation strategy; improved; improved outcome; integrated care; interest; medication for opioid use disorder; mortality; new epidemic; opioid epidemic; opioid treatment program; opioid use disorder; primary health service; process improvement; programs; research and development; scale up; service providers; skills; substance use; syndemic; systematic review; transmission process; treatment services; trial design

Project Summary This application proposes a five-year mentored training program to develop a well-trained physician-scientist in implementation science, infectious diseases, and substance use disorders. The multipronged training plan includes coursework, focused research projects, and mentorship from experts in the fields of health services research, implementation science, addiction medicine, mixed methods, and biostatistics. Implementation scientists are of critical importance to help effectively address the global burden of the dual HIV and opioid epidemics. Medications for opioid use disorder (MOUD) improve both HIV and opioid use disorder (OUD) outcomes but access to treatment has not been scaled to meet the need nor has treatment been integrated into HIV care services, despite international recommendations to do so. Implementation strategies are needed to bridge the gap between the evidence and “real-world” practices in order to increase the accessibility of MOUD to people living with HIV/OUD. The integrated Promoting Action for Research in Health Services (i-PARiHS) implementation science framework is ideally situated to scale up integration of MOUD and HIV treatment services. It posits that 3 elements are central to successful adoption and scale-up: 1) an appraisal of the strength of the evidence and meaning to practitioners, 2) an evaluation of the local context, and 3) effective facilitation. The NIATx treatment improvement model is an evidence-based practice facilitation strategy designed to increase organizational capacity to perform effective process improvement. Coaching, collaborative learning, and interest circles are utilized and allow for a tailoring of the strategy within the intended context and needs of the organization. The proposed research will be conducted in New Jersey, a state profoundly impacted by the dual opioid and HIV epidemics and has 2 of the 48 counties that are priorities for the Ending the HIV Epidemic plan. Study aims: 1) Conduct a statewide, multi-level gap analysis of treatment for HIV and OUD in New Jersey. A mixed method study will be conducted with patients, providers, clinic administrators/directors, and key stakeholders from the community/government to provide a multi-level assessment of the barriers and facilitators of integrating MOUD and HIV care/prevention. 2) Using the i-PARiHS implementation science framework, evaluate the effectiveness of using the evidence-based facilitation strategy in the NIATx Treatment Improvement Model to scale up integrated HIV and OUD services. Using a stepped-wedge cluster randomized trial design, participating HIV clinics and Opioid Treatment Programs will receive coaching (facilitation) to guide rapid cycle change projects. The primary health services outcome will be changes in MOUD prescriptions and the primary implementation outcome will be the degree of adoption of MOUD treatment in HIV settings. These research aims are supported by a complementary training and mentorship program and, taken together, will enable the candidate to become an independently-funded investigator at the intersection of infectious diseases, substance use, and implementation science.

项目概要 该申请提出了一项为期五年的指导培训计划，以培养训练有素的医师科学家 实施科学、传染病和药物滥用障碍的多管齐下的培训计划。 包括课程作业、重点研究项目以及卫生服务领域专家的指导 研究、实施科学、成瘾医学、混合方法和生物统计学。 科学家对于帮助有效解决艾滋病毒和阿片类药物的双重负担至关重要 治疗阿片类药物使用障碍 (MOUD) 的药物可改善艾滋病毒和阿片类药物使用障碍 (OUD)。 但获得治疗的机会尚未扩大以满足需要，也没有将治疗纳入 尽管有国际建议，但仍需要实施艾滋病毒护理服务。 弥合证据与“现实世界”实践之间的差距，以提高 MOUD 的可及性 卫生服务研究综合促进行动 (i-PARiHS) 实施科学框架非常适合扩大 MOUD 和艾滋病毒治疗的整合 它认为 3 个要素对于成功采用和扩大规模至关重要：1) 实力评估。 证据和对从业者的意义，2) 对当地情况的评估，以及 3) 有效的促进。 NIATx 治疗改进模型是一种基于证据的实践促进策略，旨在提高 进行有效流程改进的组织能力 辅导、协作学习和兴趣。 利用圆圈并允许根据预期背景和需求定制战略 拟议的研究将在新泽西州进行，该州深受双重影响。 阿片类药物和艾滋病毒流行，48 个县中有 2 个县是终止艾滋病毒流行计划的优先事项。 研究目的： 1) 对新泽西州的 HIV 和 OUD 治疗进行全州范围的多层次差距分析。 混合方法研究将由患者、提供者、诊所管理人员/主任和关键人员进行 来自社区/政府的利益相关者对障碍和促进因素进行多层次评估 整合 MOUD 和 HIV 护理/预防 2) 使用 i-PARiHS 实施科学框架， 评估在 NIATx 治疗改进中使用循证促进策略的有效性 使用阶梯楔形集群随机试验设计扩大艾滋病毒和 OUD 综合服务的模型， 参与的艾滋病毒诊所和阿片类药物治疗计划将接受指导（协助）以指导快速周期 初级卫生服务的成果将是 MOUD 处方和初级卫生服务的变化。 实施结果将是 MOUD 治疗在 HIV 环境中的采用程度。 得到补充培训和指导计划的支持，综合起来，将使 候选人成为传染病、物质交叉点的独立资助调查员 使用、实施和科学。