Translation of the Risk Avoidance Partnership (RAP) for Drug Treatment Clinic Imp

药物治疗诊所进出口风险规避合作伙伴关系 (RAP) 的翻译

• 批准号: 8011931
• 负责人: MARGARET R. WEEKS
• 金额: $ 24.24万
• 依托单位: INSTITUTE FOR COMMUNITY RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8011931
• 关键词: AIDS prevention; Address; Advocate; Affect; Attitude; Behavioral; Characteristics; Cities; Clinic; Clinical; Communities; Community Surveys; Connecticut; Development; Device or Instrument Development; Diffuse; Diffusion; Documentation; Drug abuse; Drug usage; Drug user; Educational Curriculum; Evaluation; Evidence based intervention; Feasibility Studies; Focus Groups; Foundations; Funding; HIV; HIV Infections; Harm Reduction; Health; Health Promotion; Health Services Research; Healthcare; Hepatitis; Illicit Drugs; Institutes; Intervention; Interview; Learning; Life; Literature; Longitudinal Studies; Maps; Measures; Methods; Modeling; Neighborhoods; Outcome; Outcome Measure; Participant; Patients; Pharmaceutical Preparations; Population; Population Heterogeneity; Pre-Post Tests; Preparation; Preventive Intervention; Process; Program Sustainability; Readiness; Research; Research Design; Risk; Risk Behaviors; Risk Reduction; Role; Sexual Partners; Social Network; Surveys; Testing; Trainers Training; Training; Translating; Translations; Trust; Variant; community intervention; community setting; design; disorder prevention; drug abuse prevention; empowerment; high risk; improved; instrument; member; peer; post intervention; prevention service; programs; public health relevance; real world application; recidivism; role model; systems research; therapy design; transmission process; treatment program

DESCRIPTION (provided by applicant): This is a three-year study entitled, Translation of the Risk Avoidance Partnership (RAP) for Drug Treatment Clinic Implementation, which uses the R34 mechanism for Pilot and Feasibility Studies in Preparation for Drug Abuse Prevention Trials. The purpose of this study is to translate the Risk Avoidance Partnership (RAP), an efficacious community intervention designed to diffuse HIV/hepatitis/STI risk reduction through drug-user networks, for use in drug treatment clinics. Strong evidence of the project's efficacy when tested in a community research setting suggests the importance and timeliness of moving it to real-world applications. The Institute for Community Research, which developed and tested the original RAP intervention, and the Hartford Dispensary, a drug-abuse treatment clinic, are partnering to translate RAP for implementation in community drug treatment clinics, while adhering to the theoretically and empirically identified core components of the RAP model, and to pilot it in one of the Dispensary clinics. In doing so, we seek to understand how the RAP intervention needs to be modified to fit the clinic context, while retaining sufficient integrity and fidelity in relation to the original design such that it potentially will achieve the same or similar outcomes among PHA trainees and their contacts, and to learn what happens when it is piloted in the clinic setting. We also seek to develop needed pre-implementation measures of clinic and community readiness and context to prepare for implementing the intervention, as well as process and fidelity measures specific to the adapted RAP-Clinic design for use when implementing the intervention. Thus, the aims of the study are to: 1. Develop and pilot pre-implementation measures to assess: a) "organizational readiness/context" of the clinics theorized to influence RAP-Clinic implementation process, outcomes, and sustainability; and b) "community context" expected to affect RAP-Clinic peer intervention implementation and diffusion. 2. Using a participatory process with HD staff and patients, a) create RAP-Clinic by modifying RAP to "fit" the clinic context while maintaining initially tested and identified RAP core components; b) develop a capacity building Training of Trainers to implement the revised design; and c) develop implementation tracking measures, including process and "fidelity" tracking forms for use during RAP-Clinic implementation. 3. Pilot the adapted RAP-Clinic intervention for feasibility and test all instruments and forms during the pilot. 4. Manualize the modified "RAP-Clinic" intervention and finalize instruments and fidelity documentation forms. Aims 1 and 2 will be conducted in years 1-2, Aim 3 in years 2-3, and Aim 4 in year 3. The development and testing of pre- and post-implementation measures (Aim 1) will be conducted in 5 of the HD branch clinics: Hartford, New Britain, Bristol, Manchester, and Windham, to allow adequate variation in clinic and community conditions and a sufficient number of staff to be interviewed for instrument development and testing. We will conduct the pilot (Aim 3) only in the Hartford branch clinic in order to avoid contamination of any of the other settings, should we choose to use them for a full RAP-Clinic test in a subsequent study. This study uses mixed qualitative (in-depth interviews, focus groups, field observations, community mapping, pilot intervention observations) and quantitative (clinic and community survey assessments, pre/post-intervention risk behavioral and social network surveys of pilot participants and their network contact referrals) to assess clinic and community characteristics relevant to intervention implementation and for process and fidelity documentation and pilot intervention outcome measures to estimate effect sizes of key outcomes. If RAP-Clinic is indicated as feasible and potentially efficacious, we will use findings and materials from this study as the foundation to conduct a full test of RAP-Clinic in a subsequent efficacy and/or services research implementation study. PUBLIC HEALTH RELEVANCE: The proposed study will translate an efficacious peer-delivered HIV prevention intervention (RAP) originally tested with active drug users in a community research setting, and to pilot it for use in drug treatment clinic settings in order to train clinic patients as Peer Health Advocates. If the pilot is successful, the translated RAP- Clinic intervention will be ready for a larger implementation test in multiple clinical settings. This proposal responds to the need for more available evidence-based interventions in real-world settings to reduce HIV risks and harms among high risk drug-using groups.

描述（由申请人提供）：这是一项为期三年的研究，题为“将风险规避伙伴关系（RAP）转化为药物治疗诊所实施”，该研究使用R34机制进行预防药物滥用试验准备的试点和可行性研究。本研究的目的是将风险避免伙伴关系（RAP）转化为药物治疗诊所的使用，RAP是一种有效的社区干预措施，旨在通过吸毒者网络传播艾滋病毒/肝炎/性传播感染风险。在社区研究环境中测试该项目的有效性的有力证据表明，将其转移到实际应用程序的重要性和及时性。社区研究所（Institute for Community Research）开发并测试了最初的RAP干预措施，而哈特福德药房（Hartford Dispensary）是一家药物滥用治疗诊所，他们正在合作，将RAP转化为社区药物治疗诊所的实施，同时坚持RAP模型的理论和经验确定的核心组成部分，并在其中一家Dispensary诊所进行试点。在此过程中，我们试图了解如何修改RAP干预以适应临床环境，同时保持与原始设计相关的足够完整性和保真度，以便它可能在PHA受训者及其接触者中实现相同或类似的结果，并了解在临床环境中进行试点时会发生什么。我们还寻求制定必要的诊所和社区准备和背景的实施前措施，为实施干预做准备，以及针对实施干预时使用的适应性RAP-Clinic设计的特定过程和保真度措施。因此，本研究的目的是：1。制定和试点实施前措施，以评估：a)理论上影响RAP-Clinic实施过程、结果和可持续性的诊所的“组织准备情况/背景”；b)“社区背景”有望影响RAP-Clinic同伴干预的实施和传播。2. 通过与房屋署员工和患者的参与式流程，a)在保留最初测试和确定的RAP核心组件的同时，通过修改RAP以“适应”诊所环境，创建RAP- clinic；b)开展培训师的能力建设培训，以实施修订后的设计；c)制定实施跟踪措施，包括在RAP-Clinic实施期间使用的过程和“保真度”跟踪表格。3. 试点适应RAP-Clinic干预的可行性，并在试点期间测试所有仪器和表格。4. 手动修改“RAP-Clinic”干预，最终确定仪器和保真度文件表格。目标1和目标2将在第1-2年进行，目标3在第2-3年进行，目标4在第3年进行。实施前和实施后措施（目标1）的制定和测试将在5个卫生署分院进行：哈特福德、新不列颠、布里斯托尔、曼彻斯特和温德姆，以使诊所和社区条件有足够的变化，并有足够数量的工作人员接受采访，以进行仪器的开发和测试。我们将只在Hartford分支诊所进行试点（目的3），以避免污染任何其他设置，如果我们选择在后续研究中使用它们进行完整的RAP-Clinic测试。本研究采用混合定性（深度访谈、焦点小组、实地观察、社区测绘、试点干预观察）和定量（诊所和社区调查评估），干预前/干预后的风险行为和社会网络调查（对试点参与者及其网络联系人转介者进行调查），以评估与干预实施相关的诊所和社区特征，并对过程和保真度文件和试点干预结果措施进行评估，以估计关键结果的效应大小。如果RAP-Clinic被认为是可行和潜在有效的，我们将使用本研究的结果和材料作为基础，在随后的疗效和/或服务研究实施研究中对RAP-Clinic进行全面测试。