Advance Care Coordination and Enhanced Linkage and Retention Among Transitional Re-Entrants Living with Hepatitis C-The HCV-ACCELERATE Trial

丙型肝炎过渡性重新进入者之间的预先护理协调以及增强的联系和保留 - HCV-ACCELERATE 试验

• 批准号: 9386036
• 负责人: Matthew Akiyama
• 金额: $ 18.47万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9386036
• 关键词: Achievement; Address; Admission activity; Adverse effects; Aftercare; Antiviral Agents; Applications Grants; Appointment; Appointments and Schedules; Award; Behavior Therapy; Caring; Cause of Death; Cirrhosis; Clinical Investigator; Cluster Analysis; Communities; Counseling; Criminal Justice; Data Analyses; Development; Discharge Plannings; Drug usage; Education; Effectiveness; Effectiveness of Interventions; Elements; Ensure; Epidemic; Foundations; Funding; Future; Goals; HIV; Health; Health Personnel; Health Transition; Healthcare; Hepatitis C; Hepatitis C Prevalence; Hepatitis C Transmission; Hospitalization; Imprisonment; Individual; Intervention; Interview; Jail; Knowledge; Lead; Length of Stay; Link; Logistics; Measures; Medical; Mentors; Mentorship; Morbidity - disease rate; Motivation; Needs Assessment; New York City; Outcome; Patient risk; Patients; Phase; Phonation; Population; Prevalence; Primary carcinoma of the liver cells; Prisons; Process Measure; Prospective Studies; Provider; Public Health; Randomized; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Risk Behaviors; Site; Social support; Statistical Data Interpretation; Structure; Substance Use Disorder; System; Telephone; Testing; Time; Training; Treatment outcome; United States; Visit; arm; base; career; career development; design; efficacy testing; experience; health care service utilization; health knowledge; high risk; improved; innovation; longitudinal analysis; mortality; peer; peer coaching; pilot trial; programs; public health intervention; randomized trial; research and development; response; skills; social cognitive theory; standard of care; virology

ABSTRACT The overarching goal of this research is to develop and test an innovative strategy to improve linkage to and retention in hepatitis C virus (HCV) treatment among individuals recently released from jail. Dr. Matthew Akiyama is proposing a K99/R00 career development and research plan which will prepare him to develop interventions to improve linkage to and retention in HCV care among individuals with criminal justice system involvement. HCV is the leading cause of cirrhosis and hepatocellular carcinoma in the United States and, as of 2007, superseded HIV as a cause of death. A strong interrelationship with substance use disorders has led to epidemic proportions of HCV in correctional settings, with a prevalence of 17.4% compared with a national HCV prevalence of only 1.3%. Care coordination programs improve linkage to care among HIV+ individuals leaving correctional settings, yet no prospective studies have evaluated the strategy of care coordination for HCV+ individuals leaving correctional settings. In addition, while peers have been used in diverse settings to address barriers to medical care and are effective at increasing health knowledge, reducing risk behaviors, and facilitating linkage to health care, peer interventions have not been studied for HCV+ individuals leaving correctional settings. Dr. Akiyama has been a key contributor to the development of a care coordination intervention for improving linkage to HCV treatment that is currently underway in the New York City jail system. This proposal builds on this experience and extends it in several important ways. The goal of the mentored (K99) phase of this proposal is to provide Dr. Akiyama with sufficient training in four key skills: 1) advanced qualitative/mixed methods research, 2) developing behavioral interventions, 3) design and conduct of randomized controlled trials in correctional settings, and 4) statistical analysis of longitudinal and clustered data specific to criminal justice populations. During the mentored (K99) phase of the award we will achieve the following specific aims: 1) To identify barriers to and facilitators of linkage to care in an existing HCV care coordination program and 2) To use the barriers and facilitators identified in Aim 1 to design an enhanced, tailored, care coordination intervention with peers as a central component. In the independent R00 phase of the award, we will 3) test the feasibility and effectiveness of the peer- enhanced, tailored, care coordination intervention using a randomized design. We hypothesize that the tailored intervention, enhanced by peers, will lead to greater rates of linkage to HCV treatment, treatment initiation, treatment completion, sustained virologic response, and lower rates of HCV risk behavior. Completion of the proposed pilot trial during the R00 phase along with intensive mentorship during the K99 phase will prepare Dr. Akiyama to test the peer-enhanced care coordination intervention in a multisite randomized controlled trial in a future R01. The proposed K99/R00 award will provide training, mentorship, and research experience that will serve as the foundation for Dr. Akiyama's career as an independently funded clinical investigator dedicated to improving health outcomes for HCV+ individuals with criminal justice system involvement.

抽象的 这项研究的总体目标是开发和测试一种创新策略来改善联系 最近从监狱释放的个人接受和保留丙型肝炎病毒（HCV）治疗。博士。 马修·秋山 (Matthew Akiyama) 提出了 K99/R00 职业发展和研究计划，这将使他做好准备 制定干预措施，以改善刑事司法人员与丙型肝炎护理的联系和保留 系统参与。 HCV 是美国肝硬化和肝细胞癌的主要原因 自 2007 年起，它已取代艾滋病毒成为死亡原因。与物质使用障碍有很强的相互关系 导致惩教机构中 HCV 流行，患病率为 17.4%，而 全国HCV患病率仅为1.3%。护理协调计划改善了艾滋病病毒感染者与护理之间的联系 离开惩教机构的个人，但没有前瞻性研究评估护理策略 协调离开惩教机构的 HCV + 个体。此外，虽然同行已被用于 多样化的环境可以解决医疗保健障碍，并有效增加健康知识，减少 危险行为以及促进与医疗保健的联系，尚未针对 HCV+ 研究同伴干预 离开惩教机构的个人。秋山博士是护理学发展的关键贡献者 目前纽约正在进行旨在改善与丙型肝炎治疗联系的协调干预措施 市监狱系统。该提案建立在这一经验的基础上，并在几个重要方面对其进行了扩展。目标是 该提案的指导（K99）阶段是为 Akiyama 博士提供四项关键技能的充分培训：1) 高级定性/混合方法研究，2) 开发行为干预措施，3) 设计和实施 惩教环境中的随机对照试验，以及 4) 纵向和聚类统计分析 针对刑事司法人群的数据。在该奖项的指导（K99）阶段，我们将实现 遵循以下具体目标： 1) 确定现有 HCV 中与护理联系的障碍和促进因素 护理协调计划，以及 2) 利用目标 1 中确定的障碍和促进因素来设计 以同伴为核心组成部分的强化、量身定制的护理协调干预。在 独立R00阶段的颁奖，我们将3）测试同行的可行性和有效性 使用随机设计增强、量身定制的护理协调干预。我们假设 由同行加强的量身定制的干预措施将提高与丙肝治疗、治疗的联系率 开始、治疗完成、持续病毒学应答以及较低的 HCV 危险行为发生率。 在 R00 阶段完成拟议的试点试验，并在 K99 阶段进行强化指导 该阶段将为 Akiyama 博士准备在多地点测试同伴强化护理协调干预措施 未来 R01 中的随机对照试验。拟议的 K99/R00 奖项将提供培训、指导和 研究经验将为秋山博士作为独立资助的科学家的职业生涯奠定基础 致力于通过刑事司法系统改善 HCV+ 个体健康结果的临床研究者 参与。