University of Washington Developmental AIDS Research Center for Mental Health (UW ARCH)

华盛顿大学心理健康发展艾滋病研究中心 (UW ARCH)

基本信息

批准号：
10816853
负责人：
Jane M. Simoni
金额：
$ 24.25万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-01 至 2025-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10816853
关键词：
AIDS prevention Acquired Immunodeficiency Syndrome Address Affect Anti-Retroviral Agents Assessment tool Awareness Caring Clinical Communities Complex Development Diagnosis Dropout Drops Drug Screening Drug usage Ensure Environment Exploration, Preparation, Implementation, and Sustainment Face Feedback Focus Groups Follow-Up Studies Fright General Population Glass Goals HIV HIV risk Health Health Services Health protection Imprisonment Individual Injections Intake Interview Intoxication Jail Justice Leadership Legal Link Measures Medical Modeling Opioid Overdose Patient Self-Report Patients Persons Pharmaceutical Preparations Phase Physicians Population Preparation Prevalence Prisons Provider Public Health Questionnaire Designs Recording of previous events Research Research Personnel Resource-limited setting Risk Risk Assessment Risk Behaviors Risk Factors Safety Scientist Screening procedure Series Services System Texas Time Toxicology Universities Unsafe Sex Urine Viral Washington Withdrawal Work addiction behavioral health care systems community based care community setting diagnostic tool disorder risk effectiveness/implementation trial evidence base experience health assessment high risk human centered design implementation facilitators implementation science implementation strategy improved injection drug use instrument medication for opioid use disorder mental health center mortality opioid overdose opioid use opioid use disorder prevention service primary care practice prison population programs routine practice routine screening screening social stigma stakeholder perspectives substance use substance use treatment tool transmission process treatment services

项目摘要

PROJECT SUMMARY/ABSTRACT People with HIV who are releasing from prison are at elevated risk of dropping out of HIV care, transmission of HIV to others, and mortality, specifically mortality due to drug overdose. Opioid use disorder (OUD) is a preventable risk factor for poor linkage to community-based HIV care, nonadherence to antiretrovirals, HIV transmission, and overdose after release from prison. Medication for OUD (MOUD) decreases HIV risk behaviors, opioid use, and overdose and is now available in many prisons, including Washington state prisons. Determining whether people have OUD is necessary to ensure that the appropriate patients initiate MOUD and link to addiction services upon release. Identification of people with OUD, however, is complex in the prison setting. Few OUD assessment tools are validated in justice-involved populations, and those that exist are not necessarily widely implemented. HIV transmission risk assessment could be integrated into OUD assessment, providing a comprehensive picture of risk and ensuring status-appropriate referrals to HIV care or prevention services upon release. We are aware of no HIV risk assessment tools that are widely used in prisons, though community-based instruments are available. Prisons are complex implementation environments, due to stigma of OUD and HIV, understaffing, and a primary focus on public safety not public health; this necessitates an implementation-focused approach to integration of OUD and HIV risk assessment. The goals of this supplement application are to 1) understand the perspectives of key stakeholders on identification of OUD and HIV risk among people in prison and 2) work with Washington prison stakeholders to select appropriate tools for OUD and HIV risk assessment and select and adapt implementation strategies to integrate these tools into routine practice. We will first conduct a total of 45 interviews with three groups of stakeholders: 1) Washington prison staff, 2) incarcerated people, and 3) recently released people with HIV or HIV risk. We will then observe existing prison health assessment practices to identify barriers and facilitators to identifying OUD and HIV risk. Finally, we will convene a focus group (n=12) that will meet four times to select tools for OUD and HIV risk assessment and adapt implementation strategies. This work will be guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework, and the focus groups will build on principles of Human Centered Design. Our experienced interdisciplinary team, led by Dr. Jack (physician- scientist practicing primary care in Washington prisons) and Dr. Hamilton (addiction health researcher with focus in criminal legal populations) will conduct this multi-staged formative study with support from an HIV expert (Dr. Graham), implementation science expert (Dr. Glass) and behavioral health assessment expert (Dr. Bradley) along with feedback from community partners. This formative work will inform a follow-up study to pilot the implementation strategies and validate an OUD assessment tool in prisons.

项目摘要/摘要从监狱中释放的艾滋病毒的人的疾病风险较高，艾滋病毒向他人的传播和死亡率，特别是由于药物过量而导致的死亡率。阿片类药物使用障碍（OUD）是与社区基于社区的艾滋病毒护理不良联系的可预防风险因素，不遵守从监狱释放后，抗逆转录病毒，艾滋病毒传播和过量用药。 OUD药物（MOUD）降低艾滋病毒风险行为，阿片类药物使用和过量，现在在许多监狱中可用，包括华盛顿州监狱。确定人们是否有Oud是必要的，以确保适当的患者发行时会发起穆德并链接到成瘾服务。但是，识别有Oud的人在监狱中很复杂。很少有OUD评估工具在与正义的人群中得到验证，并且存在的人不一定会广泛实施。艾滋病毒传播风险评估可以整合进行OUD评估，提供风险的全面图片，并确保适当的地位转介释放后的艾滋病毒护理或预防服务。我们知道没有广泛的HIV风险评估工具在监狱中使用，尽管可以使用基于社区的工具。监狱是复杂的实施环境，由于乌德（Oud）和艾滋病毒（HIV）的污名，人手不足，主要关注公共安全，而不是公共安全健康;这需要一种以实施为重点的方法来整合OUD和HIV风险评估。该补充申请的目标是1）了解主要利益相关者的观点识别监狱中的OUD和HIV风险，2）与华盛顿监狱利益相关者合作为OUD和HIV风险评估选择适当的工具，然后选择并调整实施策略将这些工具整合到常规实践中。我们将首先对三组进行45次访谈利益相关者：1）华盛顿监狱工作人员，2）被监禁的人，3）最近释放了艾滋病毒或艾滋病毒风险。然后，我们将观察现有的监狱健康评估惯例，以确定障碍和促进者确定OUD和HIV风险。最后，我们将召集一个焦点小组（n = 12），该小组将四次见面以选择 OUD和HIV风险评估和适应实施策略的工具。这项工作将由探索，准备，实施和维持（EPIS）框架，焦点小组将建立关于人类以人为中心设计的原则。我们经验丰富的跨学科团队，由杰克博士领导（医师 - 在华盛顿监狱执业的科学家）和汉密尔顿博士（成瘾健康研究员专注于刑事法律人口）将在艾滋病毒的支持下进行这项多阶段的形成性研究专家（Graham博士），实施科学专家（Glass博士）和行为健康评估专家（博士布拉德利）以及社区合作伙伴的反馈。这项形成性工作将为后续研究提供信息试行实施策略并验证监狱中的OUD评估工具。