Effectiveness of comprehensive ETE interventions in the dental setting

摘要 纽约市仍然是结束艾滋病毒流行 (ETE) 和许多医院的重要战场 基于牙科诊所的患者来自艾滋病毒高发区和流行区。此举的目标 项目旨在评估一系列基于证据的 ETE 的可接受性、可行性和有效性 对医院牙科诊所进行干预，如果早期取得成功，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信息技术（IT）干预措施，例如 电子病历 (EMR) 警报可提示进行 HIV 检测、基于平板电脑的 HIV 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结构的变化，以促进吸收 以及综合 ETE 活动的绩效。拟议项目分为几个阶段，从 与 UG3 一起评估引入 IT 增强 ETE 干预的可接受性和可行性 标准牙科团队的捆绑包（测试、预防、参与）与护理导航增强牙科 团队模型（目标 1）。如果两个模型都满足预定的可接受性和可行性阈值，我们将进行 在 UH3 的四个地点使用聚类随机模型进行比较有效性研究，以确定 最优模型（目标 2）。然后，最佳模型将在六个不同的方面进行全面实施评估 医院牙科服务站点，其中四个与曼哈顿、布鲁克林和布鲁克林的纽约长老会医院相关 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 之前没有研究检验将一整套基于证据的 ETE 干预措施引入到 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 多个机构的实施挑战。成功引入、维护和 牙科诊所中全面有效的艾滋病毒 ETE 活动的可持续性可能会被证明是一个 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.