Implementing Integrated Services for People With HIV and Opioid Use Disorder

项目摘要 本申请提出了一个为期五年的指导培训计划，以培养一个训练有素的医生，科学家， 执行科学、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，重点研究项目，以及卫生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。执行 科学家对于帮助有效解决艾滋病毒和阿片类药物双重负担至关重要 流行病阿片类药物使用障碍（MOUD）改善艾滋病毒和阿片类药物使用障碍（OUD） 但获得治疗的机会尚未按比例调整，以满足需求，也没有将治疗纳入 艾滋病毒护理服务，尽管国际上建议这样做。执行战略必须 弥合证据和“现实世界”实践之间的差距，以增加MOUD的可访问性 艾滋病病毒/OUD感染者。促进卫生服务研究综合行动（i-PARiHS） 实施科学框架是扩大MOUD和艾滋病毒治疗一体化的理想选择 服务它假定三个要素是成功采用和扩大规模的核心：1）评估 2）对当地环境的评估，以及3）有效的促进。 NIATx治疗改善模型是一种循证实践促进策略，旨在增加 组织能力，以执行有效的过程改进。辅导、协作学习和兴趣 利用循环，并允许在预期的背景和需求范围内调整战略， organization.拟议中的研究将在新泽西进行，该州深受双重疾病的影响。 阿片类药物和艾滋病毒流行病，并在48个县中有2个县是结束艾滋病毒流行病计划的优先事项。 研究目的：1）在新泽西进行全州范围内的艾滋病毒和OUD治疗的多层次差距分析。一 混合方法研究将与患者、提供者、诊所管理者/主任和关键 来自社区/政府的利益攸关方对障碍和促进因素进行多层次评估 将MOUD和艾滋病护理/预防结合起来。2)使用i-PARiHS实施科学框架， 评价在NIATx治疗改善中使用循证促进策略的有效性 扩大艾滋病毒和OUD综合服务的模式。采用阶梯楔形分组随机试验设计， 参与的艾滋病毒诊所和阿片类药物治疗计划将接受指导（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。 实施结果将是在艾滋病毒环境中采用MOUD治疗的程度。这些研究目的 得到补充培训和指导计划的支持，并将使 候选人成为一个独立资助的研究人员在传染病的交叉，物质 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.