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（埃特）的重要战场，许多医院 基于牙科的做法吸引病人从高艾滋病发病率和流行的社区。这个目标 一个项目是评估一系列基于证据的埃特的可接受性、可行性和有效性 在医院牙科诊所进行干预，然后进行强有力的实施评估， 实现了拟议的研究将利用结构信息技术（IT）干预措施，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 护理联系。我们还将探讨可能有助于吸收的牙科护理团队结构的变化 和全面埃特活动的绩效。拟议项目分为几个阶段，从 与UG3合作，评估引入信息技术强化的埃特干预措施的可接受性和可行性 捆绑（测试，预防，参与）到标准牙科团队与护理导航增强牙科 团队模型（目标1）。如果两个模型都符合预先确定的可接受性和可行性阈值，我们将进行 在UH3的四个研究中心使用聚类随机化模型进行比较有效性研究，以确定 最优模型（目标2）。然后，最佳模式将在六个不同的地点进行全面的实施评价。 医院牙科服务站点，其中四个与曼哈顿、布鲁克林和纽约的纽约长老会医院有关， 皇后区和位于布朗克斯的两个纽约市卫生和医院设施（目标3）。据我们所知 没有先前的研究检查引入一整套基于证据的埃特干预措施的潜力， 牙科护理环境，仔细关注可接受性，可行性，有效性和现实世界 多个机构的执行挑战。成功引进、维护和 在牙科实践中全面有效的HIV埃特活动的可持续性可能被证明是一个 任何成功的埃特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.