Enhanced Access to HIV Care for Drug Users in San Juan, Puerto Rico

波多黎各圣胡安吸毒者获得更多艾滋病毒护理

基本信息

批准号：
8608514
负责人：
Lisa R Metsch
金额：
$ 214.4万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-02-01 至 2018-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8608514
关键词：
AIDS/HIV problem Address Adherence Affect Alcohol or Other Drugs use Alcohols Anti-Retroviral Agents Attention Behavioral Biological Caring Communities Comorbidity Diagnosis Drops Drug usage Drug user Early identification Effectiveness Ensure Environment Epidemic Evaluation Face Failure Food Geographic state Goals HIV HIV Seropositivity Harm Reduction Health Health Services Health Services Accessibility Human immunodeficiency virus test Improve Access Incidence Individual Infection Injecting drug user Injection of therapeutic agent Interdisciplinary Study Interpersonal Violence Intervention Knowledge Legal Life Link Mental Health Modeling Morbidity - disease rate Neighborhoods Outcome Patients Persons Pharmaceutical Preparations Population Poverty Primary Health Care Process Psyche structure Psychiatric Social Work Public Health Puerto Rico Quality of life Randomized Recording of previous events Research Scientific Advances and Accomplishments Services Structure Substance Use Disorder Testing Translating Treatment Protocols United States Visit antiretroviral therapy cohort cost cost effectiveness design health care service utilization health inequalities heuristics housing instability immune function improved injection drug use innovation mHealth prevent primary outcome public health relevance screening secondary outcome social success therapy adherence transmission process uptake

项目摘要

DESCRIPTION (provided by applicant): Recent scientific advances demonstrate that for people living with HIV, antiretroviral therapy (ART) is the most effective strategy to improve immune function, reduce morbidity, improve quality of life, prolong survival, and prevent HIV transmission. Translating this knowledge into practice, however, requires prompt diagnosis and linkage to care, entry into care with timely ART initiation, and engagement in care, support for ART adherence, and retention to promote durable virologic suppression. Addressing failures in the implementation of this cascade of care, often referred to as the "Seek, Test, Treat, and Retain (STTR)" paradigm, is vital to achieving the goals of the National HIV/AIDS strategy in the United States. To date, much of the research and discussion surrounding this strategy has focused on expanding HIV testing to improve the early identification of new cases. There has been less attention focused on linkage to, engagement in, and retention in care. Specifically, little attention has focused on identifying HIV-infected individuals who, despite being aware of their diagnosis, have never been in HIV care, are intermittent users of care, or have dropped out of care. A particularly difficult subpopulation to link to and retain in HIV care are HIV-infected drug users. In Puerto Rico, drug use, especially injection drug use, continues to fuel a fast-growing HIV epidemic. Within this context, the overall goal of our proposed project is to implement and evaluate a community-level, structured approach to enhance HIV care access and retention for drug users in San Juan, Puerto Rico. The proposed intervention will be to: 1) identify drug users living with HIV who either do not know their HIV status and/or are not engaged in HIV care; 2) provide direct HIV care services through a mobile health van; and 3) support identified HIV-infected drug users with patient navigators to enhance their ability to engage in HIV care, to initiate antiretroviral therapy, and maintain adherence to their treatment regimens. We are proposing to evaluate our structural enhanced care approach through a randomized roll-out design, a refinement of the stepped-wedge design. The community-level success of the intervention will be assessed by evaluating virologic suppression (primary biological outcome), increased attendance to HIV care visits, uptake of antiretroviral therapy, adherence to HIV treatment regimens, and decreased substance use (as secondary behavioral outcomes) in an independent cohort of HIV-positive individuals drawn from each of the neighborhoods included in the intervention. We will also evaluate the implementation process and cost of the enhanced care approach including implications for cost-effectiveness, feasibility of expansion, and sustainability.

描述（由申请人提供）：最近的科学进步表明，对于艾滋病毒的患者，抗逆转录病毒疗法（ART）是提高免疫功能，降低发病率，改善生活质量，延长生存和防止HIV传播的最有效策略。但是，将这些知识转化为实践，需要迅速诊断和联系以进行护理，及时的艺术启动，参与护理，对艺术依从性的支持以及保留以促进持久的病毒学抑制。解决这种级联护理的失败，通常称为“寻求，测试，治疗和保留（STTR）”范式，对于实现美国国家艾滋病毒/艾滋病战略的目标至关重要。迄今为止，围绕该策略的许多研究和讨论都集中在扩大艾滋病毒测试，以改善对新病例的早期识别。关注与与护理的联系，参与和保留的关注较少。具体而言，很少关注的重点是识别感染的艾滋病毒感染者，尽管他们意识到自己的诊断，但从未从事过HIV护理，是间歇性的护理使用者，或者辍学了。与艾滋病毒感染的吸毒者有关，与艾滋病毒护理联系并保留的一个特别困难的亚群。在波多黎各，毒品使用，尤其是注射药物的使用，继续为快速增长的艾滋病毒流行加油。在这种情况下，我们拟议的项目的总体目标是实施和评估一种社区级别的结构化方法，以增强波多黎各圣胡安的吸毒者的艾滋病毒护理访问和保留率。拟议的干预措施将是：1）确定患有艾滋病毒的吸毒者，他们不知道自己的艾滋病毒状况和/或不从事艾滋病毒护理； 2）通过移动健康面包提供直接的艾滋病毒护理服务； 3）支持鉴定出患有患者导航剂的HIV感染的吸毒者，以增强其从事艾滋病毒护理，启动抗逆转录病毒疗法并保持对治疗方案的依从性的能力。我们提议通过随机推出设计来评估我们的结构增强护理方法，这是对阶梯式设计设计的改进。将通过评估病毒学抑制（主要的生物学结果），增加对艾滋病毒护理就诊，抗逆转录病毒疗法的吸收，对艾滋病毒治疗方案的依从性以及降低的药物使用（作为次要行为灭绝量）来评估社区水平的成功。从干预措施中包括的每个社区中提取的HIV阳性个体的独立队列。我们还将评估增强护理方法的实施过程和成本，包括对成本效益，扩张的可行性和可持续性的影响。