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

描述（由申请人提供）：这是一项为期三年的研究，题为“药物治疗诊所实施风险规避伙伴关系（RAP）的翻译”，该研究使用R34机制进行药物滥用预防试验准备的试点和可行性研究。本研究的目的是翻译风险规避伙伴关系（RAP），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/性传播感染的风险降低，用于药物治疗诊所。在社区研究环境中测试该项目的有效性的有力证据表明，将其转移到现实世界应用的重要性和及时性。社区研究所开发并测试了最初的RAP干预措施，哈特福德药房是一家药物滥用治疗诊所，正在合作将RAP转化为在社区药物治疗诊所中实施，同时坚持RAP模式的理论和经验确定的核心组成部分，并在一家药房诊所进行试点。在此过程中，我们试图了解如何修改RAP干预措施以适应临床环境，同时保留与原始设计相关的足够完整性和保真度，以便在PHA学员及其联系人中实现相同或相似的结果，并了解在临床环境中试行时会发生什么。我们还寻求制定所需的实施前措施的诊所和社区准备和背景，以准备实施干预，以及过程和保真度的措施，具体到适应RAP诊所设计时使用实施干预。因此，本研究的目的是：1。制定并试行实施前措施，以评估：a）理论上影响RAP诊所实施过程、结果和可持续性的诊所的“组织准备/背景”;以及B）预计影响RAP诊所同行干预实施和传播的“社区背景”。2.采用与HD工作人员和患者共同参与的过程，a）通过修改RAP以“适应”诊所环境，同时保持最初测试和确定的RAP核心组件，创建RAP诊所; B）开发能力建设培训师培训，以实施修订后的设计;以及c）制定实施跟踪措施，包括在RAP诊所实施期间使用的过程和“保真度”跟踪表格。3.试点适应RAP诊所干预的可行性和测试所有仪器和形式在试点期间。4.对修改后的“RAP-诊所”干预进行手册化，并最终确定仪器和保真度文件表格。目标1和2将在第1-2年进行，目标3将在第2-3年进行，目标4将在第3年进行。卫生署辖下5间分支诊所（哈特福德、新不列颠、布里斯托、曼彻斯特及温德姆）将制订及测试实施前及实施后的措施（目标1），以便诊所及社区条件有足够的变化，并有足够数目的员工接受仪器开发及测试的面试。我们将仅在Hartford分支诊所进行试点（目标3），以避免在后续研究中选择将其用于完整的RAP-诊所测试时污染任何其他设置。本研究采用混合定性（深入访谈、重点小组、实地观察、社区绘图、试点干预观察）和定量（诊所和社区调查评估，对试点参与者进行干预前/干预后风险行为和社会网络调查，以及他们的网络联系转介）评估与干预实施相关的临床和社区特征，并进行过程和保真度记录以及试点干预结果测量，以估计关键结果的效应量。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，在后续的疗效和/或服务研究实施研究中对RAP-Clinic进行全面测试。 公共卫生相关性：拟议的研究将翻译一个有效的同伴提供的艾滋病毒预防干预（RAP）最初在社区研究环境中与活跃的吸毒者进行测试，并将其用于药物治疗诊所环境中，以培训诊所患者作为同伴健康倡导者。如果试点成功，翻译后的RAP-诊所干预将准备在多个临床环境中进行更大规模的实施测试。该提案响应了现实世界环境中更多可用的循证干预措施的需求，以减少高风险吸毒群体中的艾滋病毒风险和危害。

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.