Forging sustainable solutions for HIV continuity of care through medical-legal partnerships

通过医疗法律合作伙伴关系，打造艾滋病毒连续性护理的可持续解决方案

• 批准号: 10454965
• 负责人: MIGUEL A MUNOZ-LABOY
• 金额: $ 23.6万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-21 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10454965
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Advanced Development; Affect; Appointment; Area; Behavioral; COVID-19; COVID-19 pandemic; COVID-19 prevention; COVID-19 treatment; Caring; Case Management; Client; Clinical; Clinical Trials; Communication; Communities; Comparison arm; Continuity of Patient Care; Development; Disease; Economics; Ensure; Epidemic; Evidence based intervention; Funding; Goals; Grant; HIV; HIV diagnosis; Health; Health Services; Healthcare; Homelessness; Housing; Income; Individual; Intervention; Intervention Studies; Legal; Literature; Location; Low income; Measures; Medical; Medical Care Costs; Methodology; Methods; National Institute of Mental Health; Outcome; Participant; Patient Recruitments; Patients; Persons; Pharmaceutical Preparations; Philadelphia; Population; Prevention Research; Process; Protocols documentation; Provider; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Regimen; Research; Research Priority; Resources; Risk; Service delivery model; Services; Site; Social Problems; Social Work; Structure; Testing; Time; Training; Treatment outcome; United States National Institutes of Health; Viral; Viral Load result; Vulnerable Populations; Work; acceptability and feasibility; arm; base; behavioral outcome; care outcomes; clinical care; collaborative environment; data management; efficacy trial; evidence base; feasibility testing; forging; health care availability; health care delivery; health care service organization; human data; improved; innovation; intervention mapping; medication compliance; meetings; operation; process evaluation; programs; prototype; psychosocial; public health emergency; response; service delivery; service organization; social; social determinants; social structure; standard of care; success; therapy development; treatment services

Project Summary A health-harming legal need is a social problem that adversely affects a person's health or access to health care and which is better remedied through the combination of legal care and health care. Medical legal partnerships (MLPs) have been underutilized as structural interventions; however, they could help improve HIV care continuum outcomes in health care organizations. The goal of this study is to test the Organizational Partnerships for Healthy Living (OPAHL) intervention through a feasibility and acceptability trial. OPAHL is an innovative, multilevel intervention package intended for health care organizations serving people living with HIV (PLWH). It was developed through a prior study (grant #: R21 MH115820) using intervention mapping methodology and community-scientific collaborative boards. OPAHL consists of: 1) training (7/8hours) for all MLP staff (clinical, social and behavioral services, and legal) on HIV continuum of care, health harming legal risks and needs, and MLP structure and operations to ensure that an integrated and collaborative environment is established from the earliest stages of the program; 2) case management training on the legal continuum of care; 3) embedding of legal expertise within regularized case management team meetings; 4) co- location of legal services in health care agencies through MLP inter-organizational partnership within 3 months; and 5) organizationally tailored implementation of best-practice communication and information-sharing protocols among providers within MLP, anchored in patient autonomy and choice. The specific aims of this study are: 1) to refine the OPAHL intervention prototype for implementation with PLWH with detectable viral loads and 2) to test the feasibility, acceptability and preliminary effects sizes of OPAHL. Given the current COVID-19 pandemic, the study will also explore MLP opportunities that respond at the intersection of HIV/AIDS and COVID-19 prevention and treatment. Two health care organizations serving PLWH Philadelphia, PA that do not currently provide any form of legal services to their patients will participate in this trial (n=200 PLWH). The proposed study is in response to PA-20-141: Formative and Pilot Intervention Research for Prevention and Treatment of HIV/AIDS (R34 Clinical Trial Optional). It is also responsive to two of the areas of high priority research of NIMH Division of AIDS Research (Develop and test interventions to improve HIV treatment outcomes; Advance the development and testing of interventions delivered beyond the individual level). Completion of this project will result in the development of an intervention package to optimize HIV services for a highly vulnerable population whose HIV care is affected by health-harming legal needs.

项目摘要 危害健康的法律需要是一种对人的健康或机会产生不利影响的社会问题 这一点可以通过法律护理和医疗保健相结合的方式得到更好的补救。医疗 法律伙伴关系(MLP)作为结构性干预措施没有得到充分利用；然而，它们可以有所帮助 改善卫生保健组织中艾滋病毒护理的连续结果。这项研究的目标是测试 组织健康生活伙伴关系(OPAHL)干预通过可行性和可接受性试验。 OPAHL是一种创新的、多层次的干预方案，旨在为服务于人们的医疗保健组织提供服务 艾滋病毒携带者(PLWH)。它是通过先前的研究(赠款#：R21 MH115820)使用干预开发的 测绘方法和社区-科学合作委员会。OPAHL包括：1)培训(7/8小时) 为所有MLP工作人员(临床、社会和行为服务以及法律)提供艾滋病毒持续护理、健康损害 法律风险和需求，以及MLP结构和运营，以确保集成和协作 从方案的最早阶段就建立环境；2)关于法律的案件管理培训 持续护理；3)将法律专业知识嵌入正规化的案件管理小组会议；4)共同 3个月内通过MLP组织间伙伴关系在保健机构提供法律服务； 5)有组织地实施最佳做法交流和信息共享 MLP内提供者之间的协议，以患者自主权和选择为基础。这样做的具体目的是 研究内容为：1)改进OPAHL干预原型，以便与可检测到病毒的PLWH一起实施 2)测试OPAHL的可行性、可接受性和初步效果大小。考虑到目前的情况 在新冠肺炎大流行期间，这项研究还将探索应对MLP的机会 艾滋病毒/艾滋病和新冠肺炎防治。为费城PLWH提供服务的两家医疗保健组织， 目前未向其患者提供任何形式法律服务的PA将参加这项试验(n=200 PLWH)。这项拟议的研究是对PA-20-141的回应：形成性和先导性干预研究 预防和治疗艾滋病毒/艾滋病(R34临床试验可选)。它还对以下两个领域作出反应 NIMH艾滋病研究司的高度优先研究(开发和测试改善艾滋病毒的干预措施 治疗结果；推进个人以外干预措施的开发和测试 级别)。该项目的完成将导致制定一套干预措施，以优化艾滋病毒 为高度脆弱的人群提供服务，他们的艾滋病毒护理受到危害健康的法律需求的影响。