A Cluster RCT to Increase HIV Testing in Substance Use Treatment Programs

一项旨在增加药物滥用治疗项目中艾滋病毒检测的随机对照试验

• 批准号: 9235852
• 负责人: Daniel J Feaster
• 金额: $ 159.58万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9235852
• 关键词: AIDS education; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adoption; Adult; Advisory Committees; Alcohol or Other Drugs use; Caring; Centers for Disease Control and Prevention (U.S.); Chronic Hepatitis C; Clinical Trials Network; Cluster randomized trial; Communities; Community Health; Data; Diagnosis; Drug user; Effectiveness; Eligibility Determination; Evidence based practice; General Population; HIV; HIV diagnosis; HIV risk; HIV/HCV; Health; Health Personnel; Health Services; Healthcare; Hepatitis C; Hepatitis C Prevalence; Hepatitis C virus; Human immunodeficiency virus test; Incentives; Incidence; Individual; Infection; Injecting drug user; Intervention; Joints; Life; Low income; Medicaid; Methods; National Institute of Drug Abuse; Newly Diagnosed; Opioid; Organizational Change; Outcome; Patients; Persons; Population; Prevalence; Prevention; Preventive service; Recommendation; Research; Services; Site; Staging; Substance Use Disorder; System; Technology Transfer; Test Result; Testing; Time; Training; Training Support; United States Health Resources and Services Administration; United States National Institutes of Health; United States Substance Abuse and Mental Health Services Administration; Work; World Health Organization; abstracting; addiction; arm; base; cost; cost effectiveness; curative treatments; economic value; evidence base; follow-up; health care service utilization; high risk; improved; innovation; international health organization; meetings; opioid use; prevention service; programs; theories; treatment program; uptake; willingness

Project Summary/Abstract Approximately one in eight people living with HIV in the US are unaware of their infection and the majority of adults in the US have never been HIV tested. The CDC and WHO have called for expanding HIV testing in settings where high-risk persons receive health services, including opioid treatment programs (OTPs). Persons who use opioids and other substances have high HIV risk compared with the general population; yet fewer than half of US substance use disorder (SUD) treatment programs offer on-site HIV testing and the proportion of OTPs that do has declined in the past decade. There is widespread recognition of the need for increased HIV testing and the effectiveness and economic value of on-site HIV testing in SUD treatment programs has been demonstrated. Recent recommendations from the US Preventive Services Task Force (USPSTF) that adolescents and adults should be screened for HIV in health care settings provide new opportunities for expanding access to HIV testing in OTPs. To optimize this opportunity, OTPs must address and overcome organizational-level barriers to testing, including staffing, training, concerns about delivering HIV test results and linkage to care, and the need to set up systems to support reimbursement for HIV testing services. Additionally, Hepatitis C (HCV) testing is perceived as an even greater need by some SUD programs. HCV prevalence, high among opioid users, is higher than HIV prevalence and more individuals with chronic HCV infection are unaware of their infection. Thus, we will examine whether the offer of HCV testing with HIV testing would be a motivator for adoption and implementation of HIV testing. Within this context, a 3- arm cluster-RCT of 51 OTPs will be used to test 2 active evidence-based “practice coaching” (PC) interventions to improve the provision and sustained implementation of 1) HIV testing and linkage to care and 2) joint HIV/HCV testing and linkage to care among OTP patients. In PC, change agents and key OTP staff are provided training and support to facilitate the implementation of innovation and sustain resulting improvements. Specific aims are: Aim 1: To evaluate the effectiveness of the PC interventions on improving patient uptake of HIV testing in OTPs including the incremental impact of the HIV/HCV intervention on HIV testing. Aim 2: To examine, using mixed-methods, the impact of the PC interventions on the initiation and sustained provision of HIV testing and timely linkage to care. Aim 3: To evaluate the health outcomes, health care utilization, and cost-effectiveness of the PC interventions compared incrementally to one another and to the control condition. This will be the first study to test organizational approaches to increase HIV and HIV/HCV testing and linkage to care among patients in OTPs. This proposal is aligned with the new NIH-wide priorities for HIV/AIDS research. The first priority is to reduce HIV/AIDS incidence and one of the main points is to develop, test, and implement strategies to improve HIV testing and entry into prevention services.

项目摘要/摘要 在美国，大约八分之一的艾滋病毒感染者没有意识到自己的感染，而大多数 美国的成年人从未接受过HIV测试。疾病预防控制中心，谁呼吁扩大艾滋病毒测试 高风险人员将获得卫生服务的设置，包括阿片类药物治疗计划（OTP）。 与普通人群相比，使用阿片类药物和其他物质的人具有高艾滋病毒风险；然而 我们中不到一半的药物使用障碍（SUD）治疗计划提供现场艾滋病毒测试和 在过去的十年中，DO的OTP比例有所下降。人们对需要 增加艾滋病毒测试以及SUD治疗中现场HIV测试的有效性和经济价值 已经证明了程序。美国预防服务工作队的最新建议 （USPSTF）应该在医疗保健环境中对青少年和成年人进行筛查 扩大OTP中接受HIV测试的机会。为了优化这个机会，OTP必须解决 并克服组织级测试的障碍，包括人员配备，培训，对送给艾滋病毒的担忧 测试结果和与护理的联系，以及建立系统以支持艾滋病毒测试的报销 服务。另外，丙型肝炎（HCV）测试被某些SUD认为是更大的需求 程序。在阿片类药物使用者中高的HCV患病率高于HIV患病率，更多的人 慢性HCV感染没有意识到其感染。那就是我们将检查HCV测试的提供 在这种情况下，一个3- 51个OTP的ARM Cluster-RCT将用于测试2个主动证据的“实践教练”（PC） 改善规定和持续实施的干预措施1）艾滋病毒测试和与护理的联系 2）与OTP患者的关节HIV/HCV测试和与CARA的联系。在PC中，变更代理和关键的OTP员工是 提供培训和支持，以支持实施创新并维持所得的改进。 具体目的是：目标1：评估PC干预措施对改善患者摄取的有效性 OTP中的HIV测试，包括HIV/HCV干预对HIV检测的增量影响。目标2：到 使用混合方法检查PC干预措施对主动性和持续提供的影响 艾滋病毒测试和及时连接到护理。目标3：评估健康结果，医疗保健利用和 PC干预措施的成本效益互相互相与对照条件相比。 这将是测试组织方法以增加HIV和HIV/HCV测试和联系的第一项研究 在OTP中的患者中照顾。该提案与艾滋病毒/艾滋病的新的NIH范围内的优先级保持一致 研究。首要任务是减少艾滋病毒/艾滋病事件，要点之一是开发，测试和 实施策略，以改善艾滋病毒测试和进入预防服务。