Effectiveness of comprehensive ETE interventions in the dental setting

摘要 纽约市仍然是努力结束艾滋病毒流行(ETE)和许多医院的重要战场 基于牙科实践吸引了来自艾滋病毒高发和流行社区的患者。这样做的目的是 项目是评估一系列基于证据的ETE的可接受性、可行性和有效性 以医院为基础的牙科诊所的干预措施，如果早期成功，则进行强有力的实施评估 意识到了。拟议的研究将利用结构性信息技术干预措施，例如 电子病历(EMR)警报以提示艾滋病毒检测，基于平板电脑的艾滋病毒风险评估 考虑艾滋病毒暴露前预防(PrEP)和参与仪表板以确保或重新建立 护理联动。我们还将探索牙科护理团队的结构变化，这些变化可能有助于吸收 以及全面的ETE活动的业绩。拟议的项目被分成几个阶段，从 UG3将评估引入IT增强型ETE干预的可接受性和可行性 将(测试、预防、参与)捆绑到标准牙科团队，而不是护理导航器增强的牙科 团队模型(目标1)。如果两种模式都达到了预先确定的可接受性和可行性门槛，我们将进行 在UH3的四个地点使用整群随机模型进行的比较有效性研究，以确定 最优模型(目标2)。然后，将在6个不同地点对最优模型进行全面执行评估 医院牙科服务网站，四个与曼哈顿、布鲁克林和纽约长老会医院有关的网站 皇后区和位于布朗克斯的两个纽约市卫生和医院设施(AIM 3)。据我们所知， 没有先前的研究检验将一整套基于证据的ETE干预引入到 仔细关注可接受性、可行性、有效性和现实世界的牙科护理环境 跨多个机构的实施挑战。成功的引进、维护和维护 在牙科实践中全面和有效的艾滋病毒ETE活动的可持续性很可能被证明是一个 是任何成功的ETE战略的重要组成部分。

Abstract New York City remains an important battleground in efforts to end the HIV epidemic (ETE) and many hospital based dental practices draw patients from high HIV incidence and prevalence neighborhoods. The goal of this project is to assess the acceptability, feasibility, and effectiveness of a bundle of evidence-based ETE interventions in hospital based dental clinics followed by a robust implementation evaluation if early success is realized. The proposed study will draw upon both structural information technology (IT) interventions, such as electronic medical record (EMR) alerts to prompt HIV testing, tablet-based HIV risk assessments for consideration of HIV pre-exposure prophylaxis (PrEP), and engagement dashboards to ensure or re-establish care linkage. We will also explore variations in the structure of the dental care team that might facilitate uptake and performance of comprehensive ETE activities. The proposed project is segmented into phases, commencing with the UG3 that will assess the acceptability and feasibility of introducing the IT enhanced ETE intervention bundle (testing, prevention, engagement) to a standard dental team versus care navigator augmented dental team model (Aim 1). If both models meet pre-determined acceptability and feasibility thresholds, we will conduct a comparative effectiveness study using a cluster randomized model at four sites in the UH3 to determine the optimal model (Aim 2). The optimal model will then be advanced to a full implementation evaluation at six distinct hospital dental service sites, four associated with New York Presbyterian Hospitals in Manhattan, Brooklyn and Queens and two New York City Health and Hospitals facilities located in the Bronx (Aim 3). To our knowledge no prior studies exist examining the potential of introducing a full suite of evidence-based ETE interventions into the dental care environment with careful attention to acceptability, feasibility, effectiveness and the real-world implementation challenges across multiple institutions. The successful introduction, maintenance and sustainability of comprehensive and effective HIV ETE activities in dental practices would likely prove to be a vital component of any successful ETE strategy.