Come As You Are - Assessing the Efficacy of a Nurse Case Management HIV Prevention and Care Intervention among Homeless Youth

随你而来——评估护士病例管理艾滋病毒预防和护理干预对无家可归青年的效果

• 批准号: 10064014
• 负责人: Diane M. Santa Maria
• 金额: $ 70.41万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-09 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064014
• 关键词: AIDS prevention; Address; Adherence; Adopted; Adoption; Area; Awareness; Behavior; Behavioral; Caring; Case Management; Case Manager; Clinic; Collaborations; Complex; Comprehensive Health Care; Counseling; Development; Development Plans; Education; Eligibility Determination; Feedback; Forcible intercourse; Goals; HIV; HIV Infections; HIV risk; Health; Health Insurance; Health Personnel; Health Services; Healthcare; High Prevalence; Homeless Youth; Homelessness; Housing; Human immunodeficiency virus test; Infection; Intervention; Mediating; Medical; Mental Health; Mental disorders; Methods; Modeling; Monitor; Nurses; Outcome; Population; Prevalence; Prevention; Prevention education; Prevention program; Prevention strategy; Prophylactic treatment; Public Health; Randomized Controlled Trials; Registered nurse; Research Personnel; Research Priority; Risk Behaviors; Self Efficacy; Services; Sexually Transmitted Diseases; Social Work; Technology; Testing; Time; Transportation; Trust; United States National Institutes of Health; Voting; Vulnerable Populations; Waiting Lists; Work; Youth; aged; authority; base; care delivery; condoms; coping; ethnic minority population; experience; health assessment; high risk; high risk population; housing instability; improved; infection rate; innovation; intervention effect; men who have sex with men; motivational enhancement therapy; pre-exposure prophylaxis; prevention service; preventive intervention; programs; psychosocial; racial and ethnic; risk perception; scale up; screening; service providers; sex; sexual HIV transmission; sexual risk behavior; skills; social; social health determinants; substance use; theories; treatment as usual; uptake

Youth experiencing homelessness (YEH) are at high risk for HIV, with prevalence estimates as high as 13%, underscoring the need for targeted HIV prevention programs. YEH engage in more sexual risk behaviors than stably housed youth, yet underutilize existing HIV prevention programs and prevention care delivery, including low uptake of PrEP and nPEP. Nurse case management (NCM) enhanced with motivational interviewing (MI) strategies and behavioral feedback may increase engagement of youth to adopt and adhere to behavioral and biomedical HIV prevention methods. NCM is a proven public health approach that involves coordinated, individualized, comprehensive care delivered by a registered nurse that includes health assessment, care plan development, prevention education, and health and social service navigation and addresses the social determinants of health including behavioral, psychosocial, and situational factors to optimize HIV prevention in this high risk population. Guided by the Comprehensive Health Seeking and Coping Framework, we will conduct a randomized controlled trial of an enhanced NCM intervention, NCM4HIV, delivered to YEH 16-25 years old in collaboration with health and social service providers to assess the intervention’s effect on uptake of and adherence to HIV prevention strategies. NCM4HIV is an enhanced HIV prevention case management that provides direct HIV prevention services (PrEP, nPEP) and individualized HIV prevention planning using MI and behavior feedback technology. Aim 1: Determine whether the enhanced NCM intervention increases uptake of HIV prevention strategies (PrEP and nPEP uptake, HIV testing, STI screening and treatment, and condom use) when compared with usual care received by YEH (N=450; aged 16-25 years). Aim 2: Determine whether NCM4HIV improves mental health, substance use, and housing status when compared with control youth at baseline, immediate post and 3, 6, and 9 months. As an exploratory aim, we will determine whether whether health seeking, coping, HIV risk perception, PrEP/nPEP barriers and facilitators, and condom self- efficacy mediate the effect of the intervention on uptake of PrEP/nPEP and condom use. This early-stage and new-investigator initiated R01 is significant because it has the ability to improve uptake of HIV prevention strategies and reduce new HIV cases in a high-prevalence group. NCM4HIV is innovative because it uses nurses to directly deliver enhanced NCM and can be applied to improve any existing YEH HIV prevention program, making it a highly scalable and sustainable model that capitalizes on the “come as you are” approach promoted by the National Healthcare for the Homeless Council (NHCHC). It aligns with the NIH HIV High Priority Research Areas for reducing HIV by identifying strategies to adopt, integrate, and scale up sustainable interventions in high HIV-prevalence and substance-using groups. If NCM4HIV is efficacious, we will work with NHCHC to scale it across the 300 programs and 3,300 homeless clinics that serve youth experiencing homelessness.

无家可归的青少年 (YEH) 感染艾滋病毒的风险很高，患病率估计高达 13%， 强调有针对性的艾滋病毒预防计划的必要性。 稳定安置的青年，但未充分利用现有的艾滋病毒预防计划和预防护理服务，包括 通过动机访谈 (MI) 加强 PrEP 和 nPEP 的采用率较低。 策略和行为反馈可能会增加青少年的参与度，以采用和遵守行为和行为 生物医学艾滋病毒预防方法是一种经过验证的公共卫生方法，涉及协调、 由注册护士提供个性化、全面的护理，包括健康评估、护理计划 发展、预防教育、健康和社会服务导航，并解决社会问题 健康的决定因素，包括行为、社会心理和情境因素，以优化艾滋病毒预防 在综合健康寻求和应对框架的指导下，我们将针对这一高风险人群。 对 YEH 16-25 进行增强 NCM 干预 NCM4HIV 的随机对照试验 岁与健康和社会服务提供者合作评估干预措施对吸收的影响 NCM4HIV 是一种强化的艾滋病毒预防病例管理。 使用 MI 提供直接的 HIV 预防服务（PrEP、nPEP）和个性化的 HIV 预防规划 目标1：确定增强的NCM干预是否增加。 艾滋病毒预防策略的采用（PrEP 和 nPEP 的采用、艾滋病毒检测、性传播感染筛查和治疗，以及 安全套使用）与 YEH 接受的常规护理（N=450；年龄 16-25 岁）进行比较。 与对照组相比，NCM4HIV 是否改善了心理健康、物质使用和住房状况 作为探索性目标，我们将确定是否在基线、即刻和 3 个月、6 个月和 9 个月后的青少年。 是否寻求健康、应对、HIV 风险认知、PrEP/nPEP 障碍和促进因素以及安全套自我保护 功效介导干预对 PrEP/nPEP 的吸收和安全套使用的影响。 新研究者发起的 R01 意义重大，因为它能够提高艾滋病毒预防的接受度 策略并减少高流行群体中的新艾滋病毒病例是创新的，因为它使用了。 护士提供增强型 NCM，并可直接应用于改善任何现有的 YEH HIV 预防 计划，使其成为一个高度可扩展和可持续的模型，利用“随心所欲”的方法 由国家无家可归者医疗保健委员会 (NHCHC) 推动，它与 NIH HIV High 一致。 通过确定采用、整合和扩大可持续发展战略来减少艾滋病毒的优先研究领域 如果 NCM4HIV 有效，我们将与艾滋病毒高感染率和药物滥用群体合作。 NHCHC 将其扩展到 300 个项目和 3,300 个无家可归者诊所，为青少年提供服务 无家可归。