Ending the HIV Epidemic: Peer-supported collaborative care for mental health and substance use disorder care integration into HIV care settings

结束艾滋病毒流行：同伴支持的心理健康协作护理和药物滥用障碍护理纳入艾滋病毒护理机构

• 批准号: 10670949
• 负责人: Oluwaseun Falade-Nwulia
• 金额: $ 69.79万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10670949
• 关键词: Adoption; Alcohol abuse; Anti-Retroviral Agents; Baltimore; Caring; Case Manager; Characteristics; Clinic; Clinical; Clinical Data; Continuity of Patient Care; Cost Analysis; Data; Disease; Disparity; Effectiveness; Epidemic; Evidence based treatment; Failure; Goals; HIV; HIV Infections; Health; Health Personnel; Hybrids; Individual; Intervention; Interview; Knowledge; Maintenance; Measurement; Measures; Mediator; Medication Management; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Outcome; Outcome Measure; Patient Outcomes Assessments; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Primary Care; Process; Provider; Psychiatric therapeutic procedure; Psychiatrist; Psychiatry; Questionnaires; RNA; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Self Administration; Self Management; Services; Severities; Specialist; Structure; Substance Use Disorder; Surveys; Symptoms; Time; Training; Viral; Viral Load result; addiction; alcohol use disorder; arm; behavioral health; care providers; clinical decision-making; collaborative care; computerized; cost; effectiveness evaluation; effectiveness testing; effectiveness/implementation trial; evidence base; experience; heroin use; implementation evaluation; implementation measures; implementation process; implementation science; implementation strategy; improved; innovation; medical specialties; multidisciplinary; novel; opioid use disorder; patient population; peer; peer support; primary care provider; primary care setting; programs; randomized trial; screening; sociodemographics; substance use; substance use treatment; theories; treatment as usual; treatment program

Project Abstract Despite the effectiveness of antiretroviral medications for HIV suppression, people with HIV who also have mental health and or substance use disorders suffer disparities in rates of HIV suppression and retention in HIV care. Evidence based treatment for mental health disorders (MHD) and substance use disorders (SUD), including use of medications and self-management support have been associated with improved engagement in HIV care. However, a key gap in many HIV care settings is an inability to consistently screen and provide treatment for MHD/SUD. Barriers include limited provider knowledge of, and comfort with, MHD/SUD screening and treatment; time constraints; and absence of support staff to facilitate linkage and retention in MHD/SUD care. We propose a Hybrid Type 1 implementation- effectiveness trial of an adapted collaborative care model with peer-specialists as care managers, to enhance screening and treatment for MHD/SUD with resultant improvement in rates of HIV viral suppression and care engagement in an HIV clinic setting. Collaborative care (CC), the use of a care manager/team to facilitate and coordinate integration of mental health and substance use services with primary care, is a well-established evidence-based model. We intend to adapt CC by training and supporting peer specialist to function as care managers. We will then rigorously evaluate peer-supported CC as a component of a multidisciplinary team including the HIV care provider and an addiction psychiatry consultant as an implementation strategy for MHD/SUD screening and treatment in a continuity HIV care practice. We will compare this peer-supported CC to usual care (UC) referral to psychiatric care or a SUD treatment program at the discretion of the primary care provider and evaluate the implementation process using the RE-AIM framework. Our specific aims are as follows Specific Aim 1: In a randomized trial, compare the proportion of patients with MHD/SUD with HIV suppression randomized to the collaborative care (CC) and the usual care (UC) referral strategy. We will randomize 400 patients 1:1 to CC versus UC and compare the proportion of patients with HIV suppression (defined as HIV RNA <200 copies/ml) at 12 months. Specific Aim 2: Characterize processes of CC implementation including reach, adoption, fidelity, and provider acceptability, maintenance over time, and costs associated with the approach. We propose a mixed methods approach to measure the implementation processes guided by the RE-AIM Framework. In sub Aim 2b, we will conduct a cost analysis for the peer-supported CC model. Specific Aim 3: Determine the mediators of the CC intervention on HIV viral load suppression and retention in care. We will utilize a structured questionnaire and clinical data to assess mediators of the CC intervention on HIV outcomes and qualitatively assess overall experiences with the peer supported CC model and explore if patient characteristics impact experience.

项目摘要 尽管抗逆转录病毒药物可以有效抑制艾滋病毒，但艾滋病毒感染者 心理健康和/或物质使用障碍在艾滋病毒抑制率和保留率方面存在差异 艾滋病毒护理。针对精神健康障碍（MHD）和物质使用障碍（SUD）的循证治疗， 包括使用药物和自我管理支持与提高参与度相关 在艾滋病毒护理方面。然而，许多艾滋病毒护理机构的一个关键差距是无法持续筛查和提供服务 MHD/SUD 的治疗。障碍包括提供者对 MHD/SUD 筛查的了解和舒适程度有限 和治疗；时间限制；缺乏支持人员来促进 MHD/SUD 的联系和保留 关心。我们提议对适应性协作护理进行混合 1 型实施有效性试验 与同行专家作为护理管理者的模型，以加强 MHD/SUD 的筛查和治疗 由此提高了艾滋病毒诊所环境中艾滋病毒病毒抑制率和护理参与率。 协作护理 (CC)，使用护理经理/团队来促进和协调心理整合 健康和药物使用服务与初级保健是一个完善的循证模式。我们打算 通过培训和支持同行专家担任护理经理来适应 CC。届时我们将严格 评估同行支持的 CC 作为多学科团队的组成部分，包括 HIV 护理提供者和 成瘾精神病学顾问作为 MHD/SUD 筛查和治疗的实施策略 连续性艾滋病毒护理实践。我们将比较这种同行支持的 CC 与转诊至精神科的常规护理 (UC) 由初级保健提供者自行决定的护理或 SUD 治疗计划，并评估 使用 RE-AIM 框架的实施过程。我们的具体目标如下 具体目标 1：在一项随机试验中，比较 MHD/SUD 患者与 HIV 患者的比例 抑制随机分为协作护理（CC）和常规护理（UC）转诊策略。我们将 将 400 名患者按 1:1 随机分为 CC 和 UC，并比较 HIV 抑制患者的比例 （定义为 HIV RNA <200 拷贝/ml）在 12 个月时。 具体目标 2：描述 CC 实施过程的特征，包括范围、采用、保真度和 提供商的可接受性、长期维护以及与该方法相关的成本。我们提出一个 衡量 RE-AIM 框架指导下的实施过程的混合方法。在子 目标 2b，我们将对同行支持的 CC 模型进行成本分析。 具体目标 3：确定 CC 干预对 HIV 病毒载量抑制的调节因子 保留护理。我们将利用结构化问卷和临床数据来评估 CC 的调解者 对艾滋病毒结果进行干预并定性评估同行支持的 CC 模型的总体经验 并探讨患者特征是否影响体验。