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》，它使用R34机制进行试点和可行性研究，以准备药物滥用预防试验。这项研究的目的是将风险规避伙伴关系(RAP)转化为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，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强有力证据表明，将其转移到现实世界应用程序的重要性和及时性。开发和测试最初RAP干预措施的社区研究所和药物滥用治疗诊所Hartford Dispensary正在合作翻译RAP，以便在社区药物治疗诊所实施，同时坚持RAP模式的理论和经验确定的核心组成部分，并在其中一家药房进行试点。在这样做的过程中，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受训人员及其接触者中实现相同或相似的结果，并了解当它在临床环境中试行时会发生什么。我们还寻求制定必要的实施前措施，包括诊所和社区准备情况和背景，以准备实施干预措施，以及针对调整后的RAP-Clinic设计的流程和忠诚度措施，以便在实施干预措施时使用。因此，这项研究的目的是：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/背景”；以及b)预期影响RAP-Clinic同行干预实施和传播的“社区背景”。2.利用与房屋署工作人员和患者共同参与的进程，a)通过修改RAP以“适应”临床环境，同时保留初步测试和确定的RAP核心组件，创建RAP-Clinic；b)对培训员进行能力建设培训，以实施经修订的设计；以及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.试行调整后的RAP-诊所干预措施，以确定可行性，并在试行期间测试所有仪器和表格。4.使修改后的“说唱诊所”干预措施人性化，并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将在第2-3年进行，目标4将在第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HD分支诊所进行：新不列颠哈特福德、布里斯托尔、曼彻斯特和温德姆，以使临床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，以进行仪器开发和测试。我们将只在哈特福德分部诊所进行试点(目标3)，以避免污染任何其他环境，如果我们在随后的研究中选择使用它们进行完整的RAP-Clinic测试。本研究采用定性(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(临床和社区调查评估、试点参与者干预前/干预后风险行为和社会网络调查及其网络接触转诊)相结合的方法，评估与干预实施相关的临床和社区特征，以及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果大小。如果RAP-Clinic被认为是可行和潜在有效的，我们将利用这项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。 公共卫生相关性：拟议的研究将翻译最初在社区研究环境中对活跃吸毒者进行测试的有效的同行提供的艾滋病毒预防干预(RAP)，并将其试点用于药物治疗诊所环境，以便将诊所患者培训为同伴健康倡导者。如果试点成功，转换后的RAP-诊所干预将准备好在多个临床环境中进行更大规模的实施测试。这一建议回应了在现实世界环境中需要更多可用的循证干预措施，以减少高危药物使用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.