Clinic-level implementation of mHealth to improve HIV viral suppression for patients with substance use disorders

临床层面实施移动医疗以改善药物滥用障碍患者的 HIV 病毒抑制

• 批准号: 10609091
• 负责人: Andrew Quanbeck
• 金额: $ 62.07万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10609091
• 关键词: Address; Adherence; Adoption; Appointment; Award; Awareness; Behavioral; Caring; Cellular Phone; Cities; Clinic; Clinical; Cluster randomized trial; Collaborations; Colorado; Communities; Complex; Cost Effectiveness Analysis; Cost Measures; Costs and Cost Analysis; Criminal Justice; Data; Diagnosis; Disparity; Drug usage; Effectiveness of Interventions; Epidemic; Failure; Foundations; Funding; Future; Geography; Goals; HIV; HIV Infections; HIV/AIDS; Health; Health Services Accessibility; Health system; Home; Housing; Hybrids; Incidence; Infrastructure; Internet; Intervention; Intervention Trial; Life Cycle Stages; Maintenance; Medical; Mental Health Services; Minority Groups; Missouri; Mobile Health Application; Modeling; Monitor; Patient Education; Patient Recruitments; Patients; Persons; Population; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Secure; Services; Site; Social Work; Social support; Solid; Substance Use Disorder; Support System; System; Testing; Texas; Time; Treatment outcome; United States; United States National Institutes of Health; Viral; Wisconsin; Work; addiction; alcohol misuse; antiretroviral therapy; austin; barrier to care; behavior change; care coordination; clinical care; clinical practice; design; effectiveness testing; effectiveness/implementation study; electronic health record system; ethnic disparity; ethnic minority population; evidence base; experience; food insecurity; health equity; implementation cost; implementation evaluation; implementation trial; improved; innovation; interdisciplinary approach; intervention refinement; intrinsic motivation; mHealth; medication compliance; member; mobile computing; novel strategies; patient centered medical home; patient oriented; peer; peer coaching; peer support; person centered; prevent; primary outcome; programs; provider communication; psychological distress; public health relevance; quality assurance; racial disparity; racial minority population; randomized trial; response; secondary outcome; service organization; skills; social; social determinants; social health determinants; structural health determinants; substance use; tool; transmission process; treatment adherence

PROJECT SUMMARY / ABSTRACT In response to PAR-20-036: Getting to Zero: Understanding HIV Viral Suppression and Transmission in the United States, we propose a hybrid type 2 effectiveness-implementation study that will evaluate an innovative clinic-level intervention featuring an evidence-based mobile health (mHealth) application (CHESS) and peer- driven social support. Within the infrastructure of a large HIV/AIDS Service Organization offering an integrated, patient-centered model of care in Colorado, Missouri, Texas and Wisconsin, we will implement an mHealth system designed to close information gaps, build intrinsic motivation, and develop behavioral skills needed for sustained adherence to treatment. Peer support will be provided through activities delivered by patients recruited and trained to serve as peer mentors. The mHealth system and peer mentoring will be integrated into the existing care model, known as the HIV Medical Home. We hypothesize that the integrated intervention will increase the proportion of patients with viral suppression and reduce missed clinic appointments by supporting three needs: (1) It will facilitate real-time, community-based capture of data reflecting social and behavioral determinants known to precede lapses in HIV care (e.g., housing and food insecurity, unhealthy alcohol or drug use, or poor medication adherence); (2) It will improve engagement in care by increasing social connectedness among patients, and between patients and peer mentors; and (3) It will support retention in addiction treatment and mental health care that help maintain engagement in HIV care. Project Year 1 will be devoted to planning and refinement of the intervention in close collaboration with organizational leaders and people living with HIV who are members of the local communities. Beginning in Project Year 2, we will conduct a stepped wedge cluster randomized trial of the intervention in seven clinics. We will leverage data collected through the integrated electronic health record system serving all seven clinics to test intervention effectiveness on viral suppression and retention in care. We also will conduct an implementation cost analysis and cost-effectiveness analysis to inform future sustainment of the intervention model. The study builds on a solid foundation of prior research demonstrating the promise of mHealth and peer strategies for enhancing engagement in HIV and addiction treatment and care for other complex conditions. The findings from this study, if successful, will contribute a new and innovative set of tools with high potential impact for improving HIV viral suppression in multiple geographic settings.

项目概要/摘要 响应 PAR-20-036：走向零：了解 HIV 病毒的抑制和传播 在美国，我们提出了一项混合型 2 型有效性实施研究，该研究将评估一项创新 诊所级干预以循证移动医疗 (mHealth) 应用程序 (CHESS) 和同行 带动社会支持。在大型艾滋病毒/艾滋病服务组织的基础设施内，提供综合的、 在科罗拉多州、密苏里州、德克萨斯州和威斯康星州，我们将实施以患者为中心的医疗模式 旨在缩小信息差距、建立内在动机并发展所需行为技能的系统 持续坚持治疗。将通过患者开展的活动提供同伴支持 被招募并接受培训以担任同伴导师。移动医疗系统和同伴指导将被整合到 现有的护理模式，称为艾滋病毒医疗之家。我们假设综合干预将 通过支持增加病毒抑制患者的比例并减少错过诊所预约 三个需求：(1) 它将促进基于社区的实时数据捕获，反映社会和行为 已知导致艾滋病毒护理失误的决定因素（例如住房和粮食不安全、不健康的酒精或 药物使用或服药依从性差）； （2）通过增加社会参与度来提高护理参与度 患者之间以及患者与同伴导师之间的联系； (3) 它将支持保留 成瘾治疗和心理保健，有助于维持对艾滋病毒护理的参与。项目第一年将是 致力于与组织领导者密切合作来规划和完善干预措施 属于当地社区成员的艾滋病毒感染者。从项目第二年开始，我们将进行 在七个诊所进行的阶梯式楔形集群随机干预试验。我们将利用收集的数据 通过为所有七个诊所提供服务的综合电子健康记录系统来测试干预措施 病毒抑制和护理保留的有效性。我们还将进行实施成本分析 成本效益分析，为干预模型的未来维持提供信息。该研究建立在 先前研究的坚实基础证明了移动医疗和同行战略在增强 参与艾滋病毒和成瘾治疗以及其他复杂病症的护理。由此得出的结论 研究如果成功，将提供一套新的创新工具，对改善环境具有巨大的潜在影响 在多个地理环境中抑制 HIV 病毒。