Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE)

治疗依从性、咨询和研究综合导航服务 (INSTACARE)

基本信息

批准号：
10710206
负责人：
SONJIA KENYA
金额：
$ 75.63万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-26 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10710206
关键词：
Acquired Immunodeficiency Syndrome Address Adult African American African American population African Caribbean Age Behavior Black Populations Black race Boston Caribbean region Caring Cessation of life Clinic Clinical Communities Community Health Community Health Aides Computerized Medical Record Continuity of Patient Care Counseling County Data Disparity Emigrations Enrollment Exhibits Florida Fostering Goals HIV HIV disparities HIV risk Health Health system Healthcare Healthcare Systems Homelessness Hospitalization Individual Intervention Knowledge Lesbian Gay Bisexual Transgender Queer Long-Term Care Maps Medical Records Minority Groups Modeling National Institute on Minority Health and Health Disparities Observational Study Outcome Participant Perception Persons Population Poverty Pragmatic clinical trial Public Health Public Hospitals Randomized Randomized, Controlled Trials Research Research Support Risk Behaviors Sampling Scientific Advances and Accomplishments Self Care Self Efficacy Social support Subgroup System Testing Training Unemployment Universities Viral Viral Load result Woman Work barrier to care black men clinical care community setting comparison group disparity reduction feasibility research federal poverty level health assessment health care availability health determinants health disparity implementation protocol improved intervention effect medication compliance motivational enhancement therapy pandemic disease peer support psychosocial racial discrimination racial disparity research study sexual minority sexual minority group social social health determinants socioeconomics stem treatment adherence treatment as usual treatment services trial design

项目摘要

Project Summary: The primary aim of this application is to examine the effects of a clinic-integrated community health worker (CHW) intervention on HIV outcomes among Black people with poorly managed HIV. Miami-Dade County, Florida, is an HIV epicenter where Black adults account for 17% of the population and 64% of AIDS- related deaths. These health disparities arise from the Social Determinants of Health (SDOH), the modifiable circumstances in which people grow, live, work, and age. Among Black people, negative SDOH limit healthcare access and foster racial inequities. In Miami-Dade, Black people account for ~60% of the homeless, are more than twice as likely to live below the federal poverty level, and three times more likely to be unemployed compared to the non-Black population. These disparities highlight the critical need for multi-level interventions that ameliorate the impact of the SDOH on this population. Accordingly, this application aims to examine the effects of the CHW intervention on the impact of the SDOH and system-level factors on HIV outcomes. For over 15 years, the University of Miami has supported research on CHW interventions to reduce HIV disparities. Our earlier work found Black PLH randomized to receive community based CHW support for 12 months improved rates of viral suppression vs. those receiving standard HIV care. Further research found clinic based CHW support also led to improved HIV outcomes among Black PLH. Expanding this work, this application proposes to broaden CHW support to both community and clinical settings by integrating CHWs into HIV clinical teams within Miami-Dade’s largest public health system. Feasibility research (1R56NR019755-01) elicited stakeholder input on CHW clinic integration and data was used to develop a clinic-based CHW intervention that extends care to community settings. As this work occurred during the pandemic, stakeholders were also queried on perceptions of emerging healthcare challenges and potentially responsive CHW support strategies. Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE) will embed CHWs trained in motivational interviewing into HIV clinical care teams to address SDOH, system-level factors, and individual self-care behaviors among 300 Black PLH. Using a randomized controlled trial design, participants will receive a 12-month CHW intervention or usual HIV care. As 1 in 3 local Black persons emigrated from the Caribbean, CHWs will receive robust training to utilize MI strategies with Black Caribbean subpopulations. Intervention effects on viral load, medication adherence, hospitalizations, and self-efficacy in treatment adherence at 12 months will be determined from medical records, participant tracking data and pre and post assessments. Subgroup analyses will compare outcomes between African American, Caribbean- Blacks, and LGBTQ participants. Results will contribute to knowledge on the utility of clinic- and community- based CHWs to improve HIV outcomes among Black PLH. If successful in optimizing HIV health outcomes, this research could make a substantive contribution towards reducing other health disparities in this population.

项目摘要：该应用程序的主要目的是检查诊所综合社区的影响卫生工作者 (CHW) 对艾滋病毒管理不善的迈阿密戴德黑人的艾滋病毒结果进行干预。佛罗里达州县是艾滋病毒重灾区，黑人成年人占人口的 17%，艾滋病感染者占 64%。这些健康差异源于健康的社会决定因素 (SDOH)，即可改变的因素。在黑人中，负面的 SDOH 限制了人们成长、生活、工作和衰老的环境。在迈阿密戴德郡，黑人占无家可归者的 60%，而且比例更高。生活在联邦贫困线以下的可能性是其两倍多，失业的可能性是其三倍与非黑人人口相比，这些差异凸显了多层次干预措施的迫切需要。改善 SDOH 对这一人群的影响因此，本申请旨在检查 CHW 干预对 SDOH 和系统层面因素对 HIV 结果的影响。 15 年来，迈阿密大学一直支持社区卫生工作者减少艾滋病毒干预研究我们早期的研究发现，黑人 PLH 随机接受 12 名社区社区卫生工作者的支持。进一步的研究发现，与接受标准艾滋病治疗的人相比，几个月的病毒抑制率有所提高。基于社区卫生工作者的支持还改善了黑人艾滋病患者的艾滋病毒治疗结果，扩大了这项工作，该应用程序。建议通过将社区卫生工作者纳入艾滋病毒临床工作，扩大社区卫生工作者对社区和临床环境的支持迈阿密戴德县最大的公共卫生系统内的团队进行了可行性研究 (1R56NR019755-01)。利益相关者对社区卫生工作者诊所整合和数据的投入被用来开发基于诊所的社区卫生工作者干预措施由于这项工作是在大流行期间进行的，因此利益相关者也受到了询问。关于新兴医疗保健挑战和潜在响应性社区卫生工作者支持策略的看法。治疗依从性、咨询和研究综合导航服务 (INSTACARE) 将将经过动机性访谈培训的社区卫生工作者纳入艾滋病毒临床护理团队，以解决系统层面的 SDOH 问题使用随机对照试验设计，对 300 名黑人 PLH 进行因素和个人自我保健行为。当地黑人中有三分之一的参与者将接受为期 12 个月的社区卫生工作者干预或常规艾滋病毒护理。从加勒比海移民而来的社区卫生工作者将接受严格的培训，以利用黑人加勒比海地区的 MI 策略干预对病毒载量、药物依从性、住院率和自我效能的影响。 12 个月时的治疗依从性将根据医疗记录、参与者跟踪数据和预先确定和事后评估将比较非裔美国人、加勒比人之间的结果。黑人和 LGBTQ 参与者的结果将有助于了解诊所和社区的效用。如果成功优化艾滋病毒健康结果，这项研究可以为减少该人群的其他健康差异做出实质性贡献。