Integrated eHealth for HIV and Substance Use Disorders in Justice-involved Women

针对参与司法的妇女的艾滋病毒和药物滥用障碍的综合电子保健

基本信息

批准号：
10700121
负责人：
Jaimie Meyer
金额：
$ 70.89万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10700121
关键词：
AIDS prevention Address Alabama Behavioral COVID-19 Caring Clinical Collaborations Communities Connecticut Continuity of Patient Care Criminal Justice Decision Aid Diagnosis Diversion Program Effectiveness Elements Eligibility Determination Enrollment Epidemic Epidemiology Focus Groups Follow-Up Studies Geography HIV HIV Infections HIV risk Hepatitis C Therapy Hepatitis C Transmission Individual Intervention Interview Jail Justice Life Measures Methods Modeling NIH Office of AIDS Research Opioid Outcome Output Patients Pharmaceutical Preparations Population Prisons Provider Public Health Publishing Quality-Adjusted Life Years Randomized Research Research Infrastructure Resources Risk Sampling Service delivery model Sexually Transmitted Diseases Site Standardization Stigmatization Stimulant Structure Substance Use Disorder Supervision Surveys System Techniques Testing Time Woman Work comorbidity court design eHealth evidence base health care delivery health disparity implementation barriers implementation context implementation determinants implementation evaluation implementation outcomes implementation science improved innovation medication for opioid use disorder member opioid use disorder parole pre-exposure prophylaxis preference probation recruit remote delivery scale up secondary outcome social social stigma stimulant use support tools telehealth tool treatment arm treatment as usual unethical uptake

项目摘要

Problem: There is urgent need to reach women involved in criminal justice (WICJ) for lifesaving, evidence-based PrEP and medications for OUD (MOUD), using innovative healthcare delivery models that surmount existing social and structural barriers to engagement. Purpose: We use our newly validated decision aid and eHealth to remotely deliver integrated PrEP and MOUD to community-based WICJ with OUD in New Haven, Connecticut (CT) and Birmingham, Alabama (AL). Methods: We will enroll 250 PrEP-eligible WICJ with OUD to undergo randomization to: a) the “Athena” strategy, which includes the decision aid + eHealth for remote integrated PrEP/MOUD with a provider using outputs from the decision aid; or b) decision aid-only with referral to community-based PrEP/MOUD. Randomization will be stratified by site; past 6-month use of any stimulants; and baseline receipt of MOUD. Follow-up study assessments occur at months 1, 3, and 6. To understand implementation, we will conduct population modeling and engage with relevant stakeholders through focus groups using nominal group technique and in-depth individual interviews. Aims: The Aims of the project are: 1) To compare the Athena strategy to decision aid-only in terms of patient-level engagement in the PrEP and OUD care continua, considering key site differences; and 2) To assess scale-up potential of the Athena strategy in terms of modelled long-term outcomes and how stakeholders interact with eHealth for integrated PrEP/MOUD in WICJ in two diverse epidemiological and implementation contexts (CT and AL), using standardized definitions of implementation outcomes. Significance: The proposed research directly addresses the key objectives of RFA- DA-22-040 and priorities of the NIH Office of AIDS Research by testing innovative interventions to reduce stigma and improve the PrEP and OUD care continua in the key priority population of WICJ with OUD. Importance is high due to the focus on WICJ with OUD who have high HIV risk and in whom PrEP delivery strategies are limited. Innovation is high through use of a stigma- reducing decision aid and eHealth to overcome documented barriers to PrEP uptake, and a design that measures clinical alongside implementation outcomes in two diverse settings. Feasibility is high due to access to large numbers of WICJ with OUD in both contexts and a research team with considerable content expertise, collaborations, and supportive research infrastructure. Public health significance is high because delivering PrEP to key populations is central to EHE and assessing implementation factors to guide scale-up in two diverse contexts will help guide other settings where HIV prevention is needed.

问题：迫切需要接触参与刑事司法的女性 (WICJ) 使用创新的方法挽救生命、基于证据的 PrEP 和 OUD 药物 (MOUD) 克服现有社会和结构性参与障碍的医疗保健提供模式。目的：我们使用新近验证的决策辅助和电子医疗远程提供集成的 PrEP 和 MOUD 到康涅狄格州纽黑文 (CT) 的基于社区的 WICJ 和 OUD 阿拉巴马州伯明翰 (AL) 方法：我们将通过 OUD 注册 250 名符合 PrEP 资格的 WICJ。进行随机化： a) “Athena”策略，其中包括决策辅助 + 电子健康使用决策辅助输出与提供者进行远程集成 PrEP/MOUD；或 b) 仅提供决策援助并转介至基于社区的 PrEP/MOUD 随机化将进行分层。按地点分类；过去 6 个月使用任何兴奋剂的情况；以及 MOUD 的基线接受情况。评估在第 1、3 和 6 个月进行。为了了解实施情况，我们将进行人口建模并通过焦点小组使用名义与相关利益相关者互动小组技术和深入的个人访谈。目的：该项目的目的是： 1) 将 Athena 策略与仅决策辅助策略在患者层面参与方面进行比较 PrEP 和 OUD 护理连续性，考虑关键地点差异；2) 评估扩大规模；雅典娜战略在长期成果建模方面的潜力以及利益相关者如何与 eHealth 互动，在 WICJ 中以两种不同的流行病学和实现上下文（CT 和 AL），使用标准化的实现定义结果意义：拟议的研究直接解决了 RFA 的主要目标。 DA-22-040 和 NIH 艾滋病研究办公室通过测试创新干预措施确定的优先事项减少耻辱并改善重点优先人群的 PrEP 和 OUD 护理连续性 WICJ 与 OUD 的重要性很高，因为 WICJ 与 OUD 的重点是艾滋病毒高风险人群。 PrEP 的实施策略受到限制。减少决策援助和电子卫生保健，以克服有记录的 PrEP 采用障碍，以及在两种不同的环境中测量临床结果和实施结果的设计。由于在两种情况下都可以通过 OUD 访问大量 WICJ，因此可行性很高。研究团队拥有丰富的内容专业知识、协作和支持性研究基础设施对公共卫生具有重要意义，因为向重点人群提供 PrEP 是很重要的。 EHE 的核心和评估因素的实施，以指导在两种不同背景下的扩大规模将有助于指导其他需要预防艾滋病毒的环境。