Implementing Integrated Services for People With HIV and Opioid Use Disorder

为艾滋病毒和阿片类药物使用障碍患者实施综合服务

• 批准号: 10258281
• 负责人: Amesika Nyaku
• 金额: $ 21.1万
• 依托单位: RBHS-NEW JERSEY MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10258281
• 关键词: AIDS prevention; Action Research; Address; Administrator; Adopted; Adoption; Aftercare; Area; Biometry; Caring; Clinic; Cluster randomized trial; Communicable Diseases; Communities; County; Elements; Epidemic; Evaluation; Evidence based practice; Funding; Goals; Government; HIV; HIV/HCV; Health; Health Services; Health Services Accessibility; Health Services Research; Hepatitis C Transmission; Hepatitis C virus; Injections; International; Knowledge; Lead; Learning; Measurable; Medicine; Mentors; Mentorship; Meta-Analysis; Methadone; Methods; Modeling; National Institute of Drug Abuse; New Jersey; Opioid; Outcome; Patient Care; Patients; Physicians; Positioning Attribute; Prevention; Process; Provider; Randomized; Recommendation; Reporting; Research; Research Personnel; Research Project Grants; Scientist; Services; Source; Substance Use Disorder; Training; Training Programs; Translating; Use Effectiveness; Work; addiction; antiretroviral therapy; base; care systems; contextual factors; design; educational atmosphere; effectiveness evaluation; evidence base; experience; health care delivery; health care quality; implementation framework; implementation outcomes; implementation science; implementation strategy; improved; improved outcome; interest; mortality; opioid epidemic; opioid treatment program; opioid use disorder; prescription opioid; programs; research and development; scale up; service providers; skills; substance use; systematic review; tool; transmission process; treatment services; trial design; virology

Project Summary This application proposes a five-year mentored training program to develop a well-trained physician-scientist in implementation science, infectious diseases, and substance use disorders. The multipronged training plan includes coursework, focused research projects, and mentorship from experts in the fields of health services research, implementation science, addiction medicine, mixed methods, and biostatistics. Implementation scientists are of critical importance to help effectively address the global burden of the dual HIV and opioid epidemics. Medications for opioid use disorder (MOUD) improve both HIV and opioid use disorder (OUD) outcomes but access to treatment has not been scaled to meet the need nor has treatment been integrated into HIV care services, despite international recommendations to do so. Implementation strategies are needed to bridge the gap between the evidence and “real-world” practices in order to increase the accessibility of MOUD to people living with HIV/OUD. The integrated Promoting Action for Research in Health Services (i-PARiHS) implementation science framework is ideally situated to scale up integration of MOUD and HIV treatment services. It posits that 3 elements are central to successful adoption and scale-up: 1) an appraisal of the strength of the evidence and meaning to practitioners, 2) an evaluation of the local context, and 3) effective facilitation. The NIATx treatment improvement model is an evidence-based practice facilitation strategy designed to increase organizational capacity to perform effective process improvement. Coaching, collaborative learning, and interest circles are utilized and allow for a tailoring of the strategy within the intended context and needs of the organization. The proposed research will be conducted in New Jersey, a state profoundly impacted by the dual opioid and HIV epidemics and has 2 of the 48 counties that are priorities for the Ending the HIV Epidemic plan. Study aims: 1) Conduct a statewide, multi-level gap analysis of treatment for HIV and OUD in New Jersey. A mixed method study will be conducted with patients, providers, clinic administrators/directors, and key stakeholders from the community/government to provide a multi-level assessment of the barriers and facilitators of integrating MOUD and HIV care/prevention. 2) Using the i-PARiHS implementation science framework, evaluate the effectiveness of using the evidence-based facilitation strategy in the NIATx Treatment Improvement Model to scale up integrated HIV and OUD services. Using a stepped-wedge cluster randomized trial design, participating HIV clinics and Opioid Treatment Programs will receive coaching (facilitation) to guide rapid cycle change projects. The primary health services outcome will be changes in MOUD prescriptions and the primary implementation outcome will be the degree of adoption of MOUD treatment in HIV settings. These research aims are supported by a complementary training and mentorship program and, taken together, will enable the candidate to become an independently-funded investigator at the intersection of infectious diseases, substance use, and implementation science.

项目摘要 该申请提出了一项为期五年的指导培训计划，以开发训练有素的身体科学家 实施科学，传染病和药物使用障碍。多收益培训计划 包括课程工作，重点研究项目以及卫生服务领域专家 研究，实施科学，成瘾医学，混合方法和生物统计学。执行 科学家对于有效解决双重艾滋病毒的全球负担至关重要 情节。卵毒素使用障碍（MOUD）的药物可改善艾滋病毒和蛋白质使用障碍（OUD） 结果，但尚未缩放治疗的机会以满足需求，也没有将治疗纳入 HIV护理服务，目的地国际建议这样做。需要实施策略 弥合了证据与“现实世界”实践之间的差距，以增加穆德的可及性 给感染艾滋病毒/奥德的人。综合促进卫生服务研究行动（I-Parihs） 实施科学框架是理想的位置，可以扩展MOUD和HIV治疗的整合 服务。它认为3个要素是成功采用和扩大规模的核心：1）对实力的评估 对从业者的证据和意义，2）对当地环境的评估，以及3）有效的设施。 NIATX治疗改进模型是一种基于证据的实践设施策略，旨在增加 进行有效的流程改进的组织能力。教练，协作学习和兴趣 利用了圆圈，并允许在预期的上下文和需求中量身定制该策略 组织。拟议的研究将在新泽西州进行，这个国家深刻受双重影响 Oopioid和HIV发作，有48个县中有2个是结束HIV流行计划的优先事项。 研究目的：1）在新泽西州对HIV和OUD治疗的全州范围内进行多层差距分析。一个 混合方法研究将与患者，提供者，诊所管理员/董事和密钥一起进行 社区/政府的利益相关者对障碍和促进者进行多层次评估 整合Moud和HIV护理/预防。 2）使用I-Parihs实施科学框架， 评估在NIATX治疗改进中使用基于证据的设施策略的有效性 模型以扩展综合的艾滋病毒和OUD服务。使用阶梯间簇簇随机试验设计， 参与的艾滋病毒诊所和阿片类药物治疗计划将获得教练（促进），以指导快速周期 更改项目。主要的卫生服务结果将是MOUD处方的变化和主要的 实施结果将是在艾滋病毒环境中采用MOUD治疗的程度。这些研究的目的 得到完整的培训和心态计划的支持，总的来说，将使 候选人成为传染病交集的独立资助的研究者 使用和实施科学。