Project RETAIN: Providing Integrated Care for HIV-Infected Crack Cocaine Users

RETAIN 项目：为感染艾滋病毒的快克可卡因使用者提供综合护理

基本信息

批准号：
8653837
负责人：
Lisa R Metsch
金额：
$ 119.68万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-07-15 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8653837
关键词：
AIDS prevention AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Affect Alcohol or Other Drugs use Alcohols Ambulatory Care Anti-Retroviral Agents Area Attention Buprenorphine Caring Clinic Clinical Cocaine Users Collaborations Comorbidity Complex Crack Cocaine Critical Care Development Diagnosis Drops Drug user Epidemic Experimental Designs Face Food Goals HIV HIV Infections HIV Seropositivity HIV-1 Health Health Care Seeking Behavior Health Services Accessibility Human immunodeficiency virus test Individual Intervention Life Life Style Link Mental Health Mental Health Services Modeling Newly Diagnosed Outcome Patients Pharmaceutical Preparations Population Poverty Prevention strategy Primary Health Care Provider Psychiatry Publishing Randomized Randomized Controlled Trials Reporting Research Sampling Services Site Substance Use Disorder Testing Treatment Protocols Universities Unsafe Sex Viral Load result Visit Work antiretroviral therapy efficacy testing eligible participant evidence base health inequalities high risk behavior high risk sexual behavior housing instability improved innovation medication compliance mortality prevention service primary care setting randomized trial substance abuse treatment transmission process treatment as usual

项目摘要

DESCRIPTION (provided by applicant): The "Test and Treat" paradigm has recently emerged as an innovative strategy to address the HIV/AIDS epidemic. This strategy posits that identifying HIV infected individuals through testing and linking them to care to receive prevention services and antiretroviral therapy will both improve health outcomes and reduce HIV transmission at an individual and at a population level. To date, many of the efforts and discussion surrounding this new strategy have focused on addressing increasing HIV testing for the identification of new cases of HIV infection and, to some extent, linkage of new patients to HIV care. However, considerably less attention has been given to retention in care, the critical "fourth component" of the spectrum of engagement in care and an area in which there is great need to develop intervention strategies. Furthermore, retention in HIV care of individuals who are aware of their diagnosis and have never been engaged in HIV care, who are intermittent users of care, or who have dropped out of care also needs to be addressed. A particularly difficult group to retain in HIV care is HIV-infected crack cocaine users. Within this context, this study will test, in a randomized experimental design, if a "Retention Clinic" that provides onsite evidence-based substance use and patient navigation services to HIV-positive crack cocaine users in an HIV primary care setting will improve the HIV care outcomes of HIV-infected crack cocaine users. Our proposed trial will randomize and follow 520 HIV- positive crack cocaine users that either have never been in HIV primary care or have dropped out of HIV primary care over a 12 month period to compare our integrated model's efficacy with treatment as usual. Our specific aims are: 1) To evaluate the efficacy of an integrated care model, the "Retention Clinic", in achieving virologic suppression (defined as having an HIV-1 viral load < 400 copies/ml) among HIV-infected crack cocaine users. Additionally, we will also study the efficacy of the "Retention Clinic" in a) increasing attendance at HIV care visits; b) increasing adherence to HIV treatment regimens; c) increasing attendance at substance abuse treatment and, d) decreasing substance use. The proposed approach will represent the first randomized controlled trial of an integrated substance use and patient navigation with HIV primary care for this population. This study is also innovative because there are no proven intervention strategies that address retention to HIV care with HIV-positive crack cocaine users. This study represents a collaboration between the Developmental Center for AIDS Research at the University of Miami and the Center for AIDS Research at Emory University. For the past decade, these two centers have been collaborating on issues related to HIV prevention and access to care for HIV-infected drug users.

描述（由申请人提供）：“测试和治疗”范式最近已成为解决艾滋病毒/艾滋病流行病的创新策略。该策略认为，通过测试并将其联系起来，以确定感染艾滋病毒感染的人，以便接受预防服务和抗逆转录病毒疗法，将改善健康结果，并减少个体和人群水平的艾滋病毒传播。迄今为止，围绕这一新策略的许多努力和讨论都集中在解决增加艾滋病毒感染病例的艾滋病毒测试，并在某种程度上是新患者与艾滋病毒护理的联系。但是，对保留护理的关注大大减少了，这是参与护理范围的关键“第四部分”，以及一个非常需要制定干预策略的领域。此外，保留意识到自己诊断并且从未从事过艾滋病毒护理的人，是间歇性护理使用者或退出护理的人的艾滋病毒护理。保留艾滋病毒护理的一个特别困难的群体是艾滋病毒感染的可卡因使用者。在这种情况下，这项研究将在随机实验设计中测试，如果在HIV初级保健环境中为HIV阳性裂缝可卡因使用者提供现场证据的药物使用和患者导航服务的“保留诊所”将改善HIV。艾滋病毒感染的可卡因用户的护理结果。我们提出的试验将随机分组并遵循520名HIV-阳性可卡因使用者，这些使用者既从未从事HIV初级保健，或者在12个月内退出HIV初级保健，以将我们综合模型的疗效与往常一样。我们的具体目的是：1）评估综合护理模型“保留诊所”的功效，在HIV感染的裂纹可卡因使用者中实现病毒学抑制（定义为HIV-1病毒载荷<400份/mL）。此外，我们还将研究“保留诊所”在A）增加艾滋病毒护理访问的疗效； b）增加对HIV治疗方案的依从性； c）增加对药物滥用治疗的出勤率以及d）减少药物使用。所提出的方法将代表对该人群进行综合药物使用和患者导航的第一个随机对照试验。这项研究也具有创新性，因为没有可靠的干预策略可以解决与HIV阳性裂纹可卡因使用者保留艾滋病毒护理的率。这项研究代表了迈阿密大学艾滋病研究中心与埃默里大学艾滋病研究中心之间的合作。在过去的十年中，这两个中心一直在与艾滋病毒预防和获得艾滋病毒感染的吸毒者的护理有关的问题进行合作。