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）不成比例 受艾滋病毒的影响，在艾滋病毒连续体（HIV-COC）中的参与率次优率。精神的 健康（MH）合并症有助于许多YB-GBMSM的艾滋病毒护理参与度不佳；但是，有效 包括后勤挑战，医疗不信任和MH在内的障碍阻碍了这些条件的治疗 柱头。 Ryan White Care Act支持艾滋病毒和MH服务的整合；但是，我们的初步 研究表明，在艾滋病毒的YB-GBMSM中，MH转诊率低和MH护理参与度， 即使在这些表面上集成的护理环境中。据我们所知，没有发表的干预措施 专门设计用于改善艾滋病毒感染的YB-GBMSM的MH护理参与度。这个目的 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Ryan White诊所的YB-GBMSM参与。该项目的理由是 改善服务的整合，特别是如果它们是根据文化量身定制的，可能会增加MH和HIV护理 参与YB-GBMSM。拟议的研究将追求两个具体的目的：（1）开发铃声 干涉; （2）在两个 佐治亚州亚特兰大的HRSA/Ryan白色资助的诊所 - 南部艾滋病毒中心的城市。为了 首先，我们将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 干预措施，并基于形成性数据以完善干预量的内容，并由功能启发 - 机会 - 动机行为（COM-B）模型。为了第二个目标，我们将在两个目标中实施机构 诊所环境和进行混合方法评估，其中连续数据收集由 Re-Aim（覆盖，有效性，采用，实施，维护）将用于评估 有效性和实施过程。这些目标完成后，我们将收集丰富的数据 告知随后的大规模实施试验。我们引入了重要的创新 包括综合HIV-MH护理连续体的表征以及文化和 在既定实施中开发特有YB-GBMSM的因素（障碍和促进者） 科学框架。拟议的研究很重要，因为它有潜力为有效的策略提供信息 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。