Enhancing integration of HIV and mental health services for young Black gay, bisexual and other men who have sex with men

加强针对年轻黑人同性恋、双性恋和其他男男性行为者的艾滋病毒和心理健康服务的整合

• 批准号: 10093693
• 负责人: Sophia A. Hussen
• 金额: $ 23.4万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-22 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10093693
• 关键词: Address; Adoption; Anxiety Disorders; Attitude; Behavior; Belief; Bisexual; Caring; Cities; Clinic; Clinical effectiveness; Collaborations; Continuity of Patient Care; Data; Data Aggregation; Data Collection; Depressive disorder; Development; Effectiveness; Elements; Epidemic; Evidence based intervention; Face; Funding; Future; Gays; Geographic Locations; Goals; HIV; Health; Health Services Research; Healthcare; Heart; Hybrids; Individual; Intervention; Interview; Logistics; Maintenance; Masculine; Measures; Medical; Mental Health; Mental Health Services; Methods; Modeling; Morbidity - disease rate; Motivation; NIH Office of AIDS Research; Outcome; Patients; Prevalence; Process; Process Measure; Provider; Psyche structure; Public Health; Publishing; Quality of life; Research; Services; Side; Site; Social Network; Socioeconomic Status; Substance Use Disorder; Substance-Related Disorders; Surveys; Testing; Training; Trauma; United States; United States Health Resources and Services Administration; Viral; Work; Youth; barrier to care; base; care systems; comorbidity; coping; cultural competence; data format; design; disparity reduction; effective therapy; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; ethnic minority population; health disparity; implementation research; implementation science; implementation trial; improved; innovation; meetings; men who have sex with men; mortality; multidisciplinary; pilot trial; racial disparity; screening; self reliance; sexual minority; social stigma; sociodemographics; stress related disorder; therapy design; therapy development

PROJECT SUMMARY Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV, with suboptimal rates of engagement across the HIV Continuum of Care (HIV-CoC). Mental health (MH) comorbidities contribute to poor HIV care engagement for many YB-GBMSM; however, effective treatment for these conditions is hindered by barriers including logistical challenges, medical mistrust, and MH stigma. The Ryan White Care act supports integration of HIV and MH services; however, our preliminary studies demonstrate low rates of MH referrals and MH care engagement among YB-GBMSM living with HIV, even in these ostensibly integrated care settings. To our knowledge, there are no published interventions designed specifically to improve MH care engagement among YB-GBMSM living with HIV. The objective of this R34 application is to develop and implement CHIMES (Cross-disciplinary HIV Integrated with Mental Health Support), a clinic- and provider-level intervention to improve HIV-MH care integration and MH care engagement among YB-GBMSM attending Ryan White clinics. The rationale for the project is that efforts to improve integration of services, particularly if they are culturally tailored, are likely to increase MH and HIV care engagement for YB-GBMSM. The proposed study will pursue two specific aims: (1) to develop the CHIMES intervention; and (2) to conduct a hybrid type 2 implementation-effectiveness pilot trial of CHIMES in two HRSA/Ryan White-funded clinics in Atlanta, Georgia – a city in the heart of the Southern HIV epidemic. For the first aim, we will work collaboratively with provider and patient stakeholders, adapt existing evidence-based interventions, and build on formative data to refine intervention content, informed by the Capability- Opportunity-Motivation-Behavior (COM-B) Model. For the second aim, we will implement CHIMES in the two clinic settings and conduct a mixed-methods assessment in which continuous data collection informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework will be used to evaluate effectiveness and implementation processes. Upon completion of these aims, we will have collected rich data to inform a subsequent, larger scale implementation trial of CHIMES. We introduce significant innovations including the characterization of an integrated HIV-MH care continuum and prioritization of cultural and developmental factors (both barriers and facilitators) specific to YB-GBMSM within established implementation science frameworks. The proposed research is significant because of its potential to inform effective strategies for improving HIV viral suppression and quality of life among YB-GBMSM, leading to improved individual and public health outcomes in line with the goals of the Ending the HIV Epidemic initiative.

项目摘要 年轻的黑人同性恋，双性恋和其他与男人发生性关系的男人（YB-GBMSM） 受艾滋病毒的影响，英语次数次优。 健康（MH）合并症为许多YB-GBMSM贡献了hiv的护理 障碍物包括后勤挑战，医疗不信任和MH，阻碍了对含量的治疗 污名。 研究表明，MH转介和MH护理率低的比率较低 据我们所知，即使在这些综合护理环境中，也没有发表的介入 专门为改善与艾滋病毒的YB-GBMSM之间的MH护理参与。 R34的应用是开发和实施机构（跨学科HIV与心理健康融合 支持），一种诊所和提供商级干预措施，以改善HIV-MH护理整合和​​MH护理 参加Ryanwite诊所的YB-GBMSM参与。 改善服务的整合，尤其是在文化量身定制的情况下，可能会增加MH和HIB护理护理护理护理护理护理护理。 YB-GBMSM的参与将追求两个具体的目标：（1） 间隔； HRSA/Ryan White资助的诊所位于佐治亚州的亚特兰大 - 南部艾滋病毒中心的城市。 首先，我们与提供者和患者利益相关者合作，适应现有的基于证据的现有 间隔名称，并基于形成性数据以完善干预内容，以功能为导致 机会 - 动机行为（COM-B）模型。 诊所环境和进行混合方法评估，其中连续数据收集由Thee告知 Re-Aim（触及，有效，采用，实施，维护）框架将用于评估 有效性和实施过程。 引入重大创新。 包含综合HIV-MH护理连续体的表征和文化优先级 在已建立的Implation实施中特有的YB-GBMSM特有的发展因素（障碍和促进者） 科学框架。 为了改善YB-GBMSM中艾滋病毒抑制和生活质量，从而改善了个体和 公共卫生结果符合结束艾滋病毒流行倡议的目标。