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.

项目概要 损害健康的法律需求是对一个人的健康或获取产生不利影响的社会问题 医疗保健，通过法律保健和医疗保健的结合可以更好地解决这一问题。医疗的 法律伙伴关系（MLP）作为结构性干预措施并未得到充分利用；然而，他们可以帮助 改善卫生保健组织的艾滋病毒护理连续结果。本研究的目的是测试 健康生活组织伙伴关系 (OPAHL) 通过可行性和可接受性试验进行干预。 OPAHL 是一种创新的多层次干预方案，旨在为为人们服务的医疗保健组织提供服务 艾滋病毒感染者（PLWH）。它是通过之前的一项研究（授权号：R21 MH115820）使用干预措施开发的 制图方法和社区科学合作委员会。 OPAHL 包括： 1) 培训（7/8 小时） 针对所有 MLP 工作人员（临床、社会和行为服务以及法律）关于艾滋病毒持续护理、健康危害的问题 法律风险和需求，以及 MLP 结构和运营，以确保集成和协作 环境是从项目的最早阶段就建立的； 2）案件管理法律培训 持续的护理； 3) 将法律专业知识纳入定期的案件管理团队会议中； 4) 共同 在 3 个月内通过 MLP 组织间合作伙伴关系在医疗保健机构中提供法律服务； 5) 有组织地定制实施最佳实践沟通和信息共享 MLP 内提供者之间的协议，以患者的自主权和选择为基础。本次活动的具体目标 研究内容是： 1) 完善 OPAHL 干预原型，以便在可检测到病毒的 PL​​WH 中实施 2) 测试 OPAHL 的可行性、可接受性和初步效果大小。鉴于当前 COVID-19 大流行期间，该研究还将探索 MLP 的机会，以应对 HIV/艾滋病和 COVID-19 的预防和治疗。为费城 PLWH 提供服务的两个医疗保健组织， 目前不向患者提供任何形式法律服务的 PA 将参加本次试验（n=200） 感染者）。拟议的研究是为了回应 PA-20-141：形成性和试点干预研究 HIV/AIDS 的预防和治疗（R34 临床试验可选）。它还响应以下两个领域 NIMH 艾滋病研究部门的高度优先研究（开发和测试改善艾滋病毒的干预措施 治疗结果；推进个人干预措施的开发和测试 等级）。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，这些人群的艾滋病毒护理受到损害健康的法律需求的影响。