Translation of the Risk Avoidance Partnership (RAP) for Drug Treatment Clinic Imp

药物治疗诊所进出口风险规避合作伙伴关系 (RAP) 的翻译

• 批准号: 8300181
• 负责人: MARGARET R. WEEKS
• 金额: $ 12.43万
• 依托单位: INSTITUTE FOR COMMUNITY RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8300181
• 关键词: AIDS prevention; Address; Advocate; Affect; Attitude; Behavioral; Characteristics; Cities; Clinic; Clinical; Communities; Community Surveys; Connecticut; Development; Device or Instrument Development; Diffuse; Diffusion; Documentation; Drug abuse; Drug usage; Drug user; Educational Curriculum; Evaluation; Evidence based intervention; Feasibility Studies; Focus Groups; Foundations; Funding; HIV; HIV Infections; Harm Reduction; Health; Health Promotion; Health Services Research; Healthcare; Hepatitis; Illicit Drugs; Institutes; Intervention; Interview; Learning; Literature; Longitudinal Studies; Maps; Measures; Methods; Modeling; National Institute of Drug Abuse; Neighborhoods; Outcome; Outcome Measure; Participant; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Population Heterogeneity; Preparation; Preventive Intervention; Process; Program Sustainability; Readiness; Research; Research Design; Risk; Risk Behaviors; Risk Reduction; Role; Sexual Partners; Social Network; Surveys; Testing; Trainers Training; Training; Translating; Translations; Trust; Variant; community intervention; community setting; design; disorder prevention; disorder risk; drug abuse prevention; empowerment; high risk; improved; instrument; member; peer; post intervention; prevention service; programs; public health relevance; real world application; recidivism; role model; systems research; therapy design; transmission process; treatment program

DESCRIPTION (provided by applicant): This is a three-year study entitled, Translation of the Risk Avoidance Partnership (RAP) for Drug Treatment Clinic Implementation, which uses the R34 mechanism for Pilot and Feasibility Studies in Preparation for Drug Abuse Prevention Trials. The purpose of this study is to translate the Risk Avoidance Partnership (RAP), an efficacious community intervention designed to diffuse HIV/hepatitis/STI risk reduction through drug-user networks, for use in drug treatment clinics. Strong evidence of the project's efficacy when tested in a community research setting suggests the importance and timeliness of moving it to real-world applications. The Institute for Community Research, which developed and tested the original RAP intervention, and the Hartford Dispensary, a drug-abuse treatment clinic, are partnering to translate RAP for implementation in community drug treatment clinics, while adhering to the theoretically and empirically identified core components of the RAP model, and to pilot it in one of the Dispensary clinics. In doing so, we seek to understand how the RAP intervention needs to be modified to fit the clinic context, while retaining sufficient integrity and fidelity in relation to the original design such that it potentially will achieve the same or similar outcomes among PHA trainees and their contacts, and to learn what happens when it is piloted in the clinic setting. We also seek to develop needed pre-implementation measures of clinic and community readiness and context to prepare for implementing the intervention, as well as process and fidelity measures specific to the adapted RAP-Clinic design for use when implementing the intervention. Thus, the aims of the study are to: 1. Develop and pilot pre-implementation measures to assess: a) "organizational readiness/context" of the clinics theorized to influence RAP-Clinic implementation process, outcomes, and sustainability; and b) "community context" expected to affect RAP-Clinic peer intervention implementation and diffusion. 2. Using a participatory process with HD staff and patients, a) create RAP-Clinic by modifying RAP to "fit" the clinic context while maintaining initially tested and identified RAP core components; b) develop a capacity building Training of Trainers to implement the revised design; and c) develop implementation tracking measures, including process and "fidelity" tracking forms for use during RAP-Clinic implementation. 3. Pilot the adapted RAP-Clinic intervention for feasibility and test all instruments and forms during the pilot. 4. Manualize the modified "RAP-Clinic" intervention and finalize instruments and fidelity documentation forms. Aims 1 and 2 will be conducted in years 1-2, Aim 3 in years 2-3, and Aim 4 in year 3. The development and testing of pre- and post-implementation measures (Aim 1) will be conducted in 5 of the HD branch clinics: Hartford, New Britain, Bristol, Manchester, and Windham, to allow adequate variation in clinic and community conditions and a sufficient number of staff to be interviewed for instrument development and testing. We will conduct the pilot (Aim 3) only in the Hartford branch clinic in order to avoid contamination of any of the other settings, should we choose to use them for a full RAP-Clinic test in a subsequent study. This study uses mixed qualitative (in-depth interviews, focus groups, field observations, community mapping, pilot intervention observations) and quantitative (clinic and community survey assessments, pre/post-intervention risk behavioral and social network surveys of pilot participants and their network contact referrals) to assess clinic and community characteristics relevant to intervention implementation and for process and fidelity documentation and pilot intervention outcome measures to estimate effect sizes of key outcomes. If RAP-Clinic is indicated as feasible and potentially efficacious, we will use findings and materials from this study as the foundation to conduct a full test of RAP-Clinic in a subsequent efficacy and/or services research implementation study. PUBLIC HEALTH RELEVANCE: The proposed study will translate an efficacious peer-delivered HIV prevention intervention (RAP) originally tested with active drug users in a community research setting, and to pilot it for use in drug treatment clinic settings in order to train clinic patients as Peer Health Advocates. If the pilot is successful, the translated RAP- Clinic intervention will be ready for a larger implementation test in multiple clinical settings. This proposal responds to the need for more available evidence-based interventions in real-world settings to reduce HIV risks and harms among high risk drug-using groups.

描述（由申请人提供）：这是一项为期三年的研究，题为“药物治疗诊所实施风险规避伙伴关系（RAP）的翻译”，该研究使用 R34 机制进行试点和可行性研究，以准备药物滥用预防试验。本研究的目的是将风险规避伙伴关系 (RAP) 转化为药物治疗诊所的使用，这是一种有效的社区干预措施，旨在通过吸毒者网络传播降低艾滋病毒/肝炎/性传播感染风险的方法。在社区研究环境中进行测试时，该项目功效的有力证据表明将其转移到现实世界应用程序的重要性和及时性。开发和测试最初的 RAP 干预措施的社区研究所和药物滥用治疗诊所哈特福德药房正在合作翻译 RAP，以便在社区药物治疗诊所实施，同时坚持理论和经验确定的核心组成部分RAP 模型，并在其中一间药房诊所进行试点。在此过程中，我们试图了解如何修改 RAP 干预措施以适应临床环境，同时保留与原始设计相关的足够的完整性和保真度，以便有可能在 PHA 受训者及其患者中实现相同或相似的结果接触，并了解在诊所环境中试点时会发生什么。我们还寻求制定必要的实施前措施，以衡量诊所和社区的准备情况和背景，为实施干预措施做好准备，以及针对实施干预措施时使用的经过调整的 RAP-Clinic 设计而制定的流程和保真度措施。因此，本研究的目的是： 1. 制定和试点实施前措施，以评估： a) 理论上影响 RAP-Clinic 实施过程、结果和可持续性的诊所的“组织准备情况/背景”； b) 预计会影响 RAP-Clinic 同伴干预实施和传播的“社区背景”。 2. 使用 HD 工作人员和患者的参与过程，a) 通过修改 RAP 以“适应”诊所环境，同时保持最初测试和确定的 RAP 核心组件，创建 RAP 诊所； b) 开展培训师能力建设培训以实施修订后的设计； c) 制定实施跟踪措施，包括在 RAP-Clinic 实施期间使用的流程和“保真度”跟踪表格。 3. 试点调整后的 RAP-Clinic 干预措施的可行性，并在试点期间测试所有工具和表格。 4. 对修改后的“RAP-Clinic”干预进行手动操作，并最终确定工具和保真文档表格。目标 1 和 2 将在第 1-2 年实施，目标 3 将在第 2-3 年实施，目标 4 将在第 3 年实施。实施前和实施后措施（目标 1）的制定和测试将在第 5 年实施。 HD 分支机构诊所：哈特福德、新不列颠、布里斯托尔、曼彻斯特和温德姆，以允许诊所和社区条件有足够的变化，并有足够数量的工作人员接受仪器开发和测试的采访。我们将仅在哈特福德分诊所进行试点（目标 3），以避免污染任何其他设置（如果我们选择在后续研究中使用它们进行完整的 RAP-Clinic 测试）。本研究采用混合定性（深入访谈、焦点小组、实地观察、社区绘图、试点干预观察）和定量（诊所和社区调查评估、干预前/后试点参与者及其网络的风险行为和社交网络调查）联系转介）以评估与干预实施相关的诊所和社区特征，以及流程和保真度记录以及试点干预结果措施，以估计关键结果的效果大小。如果 RAP-Clinic 被证明可行且可能有效，我们将使用本研究的结果和材料作为基础，在后续的功效和/或服务研究实施研究中对 RAP-Clinic 进行全面测试。 公共健康相关性：拟议的研究将转化一项有效的同行提供的艾滋病毒预防干预措施（RAP），该干预措施最初是在社区研究环境中对活跃吸毒者进行测试的，并将其试点用于戒毒治疗诊所环境，以便培训临床患者同伴健康倡导者。如果试点成功，翻译后的 RAP-Clinic 干预措施将准备好在多个临床环境中进行更大规模的实施测试。该提案满足了现实世界中需要更多可用的循证干预措施的需求，以减少高危吸毒群体的艾滋病毒风险和危害。