Implementing Integrated Services for People With HIV and Opioid Use Disorder

项目摘要 本申请提出了一项为期五年的导师培训计划，以培养一名训练有素的内科科学家 实施科学、传染病和物质使用障碍。多管齐下的培训计划 包括课程作业、有重点的研究项目和健康服务领域专家的指导 研究、实施科学、成瘾医学、混合方法和生物统计学。实施 科学家对帮助有效应对艾滋病毒和阿片类药物双重全球负担至关重要 流行病。治疗阿片使用障碍的药物(Moud)改善艾滋病毒和阿片使用障碍(OUD) 结果，但获得治疗的机会没有扩大到满足需要，治疗也没有纳入 艾滋病毒护理服务，尽管国际社会建议这样做。需要实施战略来 弥合证据和“现实世界”实践之间的差距，以增加Moud的可及性 给艾滋病毒携带者/OUD患者。卫生服务研究综合促进行动(I-PARiHS) 实施科学框架是扩大穆德和艾滋病毒治疗整合的理想位置 服务。它认为三个要素是成功采用和扩大规模的核心：1)强度评估 对实践者的证据和意义，2)对当地背景的评估，以及3)有效的促进。 NIATx治疗改进模式是一种基于证据的实践促进策略，旨在提高 执行有效流程改进的组织能力。指导、协作学习和兴趣 利用圆圈，并允许在预期的背景和需求内对战略进行定制 组织。这项拟议的研究将在新泽西州进行，新泽西州深受这两个州的影响 阿片类药物和艾滋病毒流行，在48个县中有2个是结束艾滋病毒流行计划的优先事项。 研究目标：1)对新泽西州HIV和OUD的治疗进行全州范围内、多层次的差距分析。一个 将与患者、提供者、诊所管理员/主任和关键人员进行混合方法研究 来自社区/政府的利益相关者提供对障碍和促进者的多层次评估 将穆德与艾滋病毒护理/预防相结合。2)使用I-PARiHS实施科学框架， 评价循证易化策略在NIATx治疗改进中的有效性 扩大艾滋病毒和艾滋病综合服务的模式。采用阶梯式楔形群随机试验设计， 参与艾滋病毒诊所和阿片类药物治疗计划的人员将接受指导(促进)，以指导快速周期 更改项目。初级卫生服务的结果将是Moud处方和初级卫生服务的变化 执行结果将是在艾滋病毒环境中采用穆德治疗的程度。这些研究的目的是 都得到了补充培训和指导计划的支持，这些计划加在一起将使 候选人将成为传染病、物质交叉领域的独立资金调查员 使用和实施科学。

Project Summary This application proposes a five-year mentored training program to develop a well-trained physician-scientist in implementation science, infectious diseases, and substance use disorders. The multipronged training plan includes coursework, focused research projects, and mentorship from experts in the fields of health services research, implementation science, addiction medicine, mixed methods, and biostatistics. Implementation scientists are of critical importance to help effectively address the global burden of the dual HIV and opioid epidemics. Medications for opioid use disorder (MOUD) improve both HIV and opioid use disorder (OUD) outcomes but access to treatment has not been scaled to meet the need nor has treatment been integrated into HIV care services, despite international recommendations to do so. Implementation strategies are needed to bridge the gap between the evidence and “real-world” practices in order to increase the accessibility of MOUD to people living with HIV/OUD. The integrated Promoting Action for Research in Health Services (i-PARiHS) implementation science framework is ideally situated to scale up integration of MOUD and HIV treatment services. It posits that 3 elements are central to successful adoption and scale-up: 1) an appraisal of the strength of the evidence and meaning to practitioners, 2) an evaluation of the local context, and 3) effective facilitation. The NIATx treatment improvement model is an evidence-based practice facilitation strategy designed to increase organizational capacity to perform effective process improvement. Coaching, collaborative learning, and interest circles are utilized and allow for a tailoring of the strategy within the intended context and needs of the organization. The proposed research will be conducted in New Jersey, a state profoundly impacted by the dual opioid and HIV epidemics and has 2 of the 48 counties that are priorities for the Ending the HIV Epidemic plan. Study aims: 1) Conduct a statewide, multi-level gap analysis of treatment for HIV and OUD in New Jersey. A mixed method study will be conducted with patients, providers, clinic administrators/directors, and key stakeholders from the community/government to provide a multi-level assessment of the barriers and facilitators of integrating MOUD and HIV care/prevention. 2) Using the i-PARiHS implementation science framework, evaluate the effectiveness of using the evidence-based facilitation strategy in the NIATx Treatment Improvement Model to scale up integrated HIV and OUD services. Using a stepped-wedge cluster randomized trial design, participating HIV clinics and Opioid Treatment Programs will receive coaching (facilitation) to guide rapid cycle change projects. The primary health services outcome will be changes in MOUD prescriptions and the primary implementation outcome will be the degree of adoption of MOUD treatment in HIV settings. These research aims are supported by a complementary training and mentorship program and, taken together, will enable the candidate to become an independently-funded investigator at the intersection of infectious diseases, substance use, and implementation science.