Project RETAIN: Providing Integrated Care for HIV-Infected Crack Cocaine Users

RETAIN 项目：为感染艾滋病毒的快克可卡因使用者提供综合护理

• 批准号: 8517243
• 负责人: Lisa R Metsch
• 金额: $ 129.75万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-15 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8517243
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Alcohol or Other Drugs use; Alcohols; Ambulatory Care; Anti-Retroviral Agents; Area; Attention; Buprenorphine; Caring; Clinic; Clinical; Cocaine Users; Collaborations; Comorbidity; Complex; Crack Cocaine; Critical Care; Development; Diagnosis; Drops; Drug user; Epidemic; Experimental Designs; Face; Food; Goals; HIV; HIV Infections; HIV Seropositivity; HIV-1; Health; Health Care Seeking Behavior; Health Services Accessibility; Human immunodeficiency virus test; Individual; Intervention; Life; Life Style; Link; Mental Health; Mental Health Services; Modeling; Newly Diagnosed; Outcome; Patients; Pharmaceutical Preparations; Population; Poverty; Prevention strategy; Primary Health Care; Provider; Psychiatry; Publishing; Randomized; Randomized Controlled Trials; Reporting; Research; Sampling; Services; Site; Substance Use Disorder; Testing; Treatment Protocols; Universities; Unsafe Sex; Viral Load result; Visit; Work; antiretroviral therapy; efficacy testing; eligible participant; evidence base; health inequalities; high risk behavior; high risk sexual behavior; housing instability; improved; innovation; medication compliance; mortality; prevention service; primary care setting; randomized trial; substance abuse treatment; transmission process; treatment as usual

DESCRIPTION (provided by applicant): The "Test and Treat" paradigm has recently emerged as an innovative strategy to address the HIV/AIDS epidemic. This strategy posits that identifying HIV infected individuals through testing and linking them to care to receive prevention services and antiretroviral therapy will both improve health outcomes and reduce HIV transmission at an individual and at a population level. To date, many of the efforts and discussion surrounding this new strategy have focused on addressing increasing HIV testing for the identification of new cases of HIV infection and, to some extent, linkage of new patients to HIV care. However, considerably less attention has been given to retention in care, the critical "fourth component" of the spectrum of engagement in care and an area in which there is great need to develop intervention strategies. Furthermore, retention in HIV care of individuals who are aware of their diagnosis and have never been engaged in HIV care, who are intermittent users of care, or who have dropped out of care also needs to be addressed. A particularly difficult group to retain in HIV care is HIV-infected crack cocaine users. Within this context, this study will test, in a randomized experimental design, if a "Retention Clinic" that provides onsite evidence-based substance use and patient navigation services to HIV-positive crack cocaine users in an HIV primary care setting will improve the HIV care outcomes of HIV-infected crack cocaine users. Our proposed trial will randomize and follow 520 HIV- positive crack cocaine users that either have never been in HIV primary care or have dropped out of HIV primary care over a 12 month period to compare our integrated model's efficacy with treatment as usual. Our specific aims are: 1) To evaluate the efficacy of an integrated care model, the "Retention Clinic", in achieving virologic suppression (defined as having an HIV-1 viral load < 400 copies/ml) among HIV-infected crack cocaine users. Additionally, we will also study the efficacy of the "Retention Clinic" in a) increasing attendance at HIV care visits; b) increasing adherence to HIV treatment regimens; c) increasing attendance at substance abuse treatment and, d) decreasing substance use. The proposed approach will represent the first randomized controlled trial of an integrated substance use and patient navigation with HIV primary care for this population. This study is also innovative because there are no proven intervention strategies that address retention to HIV care with HIV-positive crack cocaine users. This study represents a collaboration between the Developmental Center for AIDS Research at the University of Miami and the Center for AIDS Research at Emory University. For the past decade, these two centers have been collaborating on issues related to HIV prevention and access to care for HIV-infected drug users.

描述（由申请人提供）：“检测和治疗”模式最近成为解决艾滋病毒/艾滋病流行病的创新战略。该战略认为，通过检测查明艾滋病毒感染者，并将他们与护理联系起来，以获得预防服务和抗逆转录病毒治疗，将改善健康成果，减少个人和人口一级的艾滋病毒传播。迄今为止，围绕这一新战略所作的许多努力和讨论都侧重于增加艾滋病毒检测，以发现新的艾滋病毒感染病例，并在一定程度上将新病人与艾滋病毒护理联系起来。然而，对继续接受照料的关注却少得多，而这是照料工作范围中至关重要的“第四个组成部分”，也是非常需要制定干预战略的一个领域。此外，还需要解决让那些知道自己被诊断出患有艾滋病毒但从未接受过艾滋病毒护理的人、间歇性接受护理的人或已退出护理的人继续接受艾滋病毒护理的问题。一个特别难以在艾滋病毒护理中留住的群体是感染艾滋病毒的快克可卡因使用者。在此背景下，本研究将测试，在随机实验设计，如果“保留诊所”，提供现场循证药物使用和患者导航服务，以艾滋病毒阳性快克可卡因用户在艾滋病毒初级保健设置将改善艾滋病毒感染快克可卡因用户的艾滋病毒护理结果。我们拟议的试验将随机分配并跟踪520名HIV阳性快克可卡因使用者，这些人从未接受过HIV初级保健或在12个月内退出HIV初级保健，以比较我们的综合模型与常规治疗的疗效。我们的具体目标是：1）评估综合护理模式，“保留诊所”，在艾滋病毒感染的快克可卡因使用者中实现病毒学抑制（定义为HIV-1病毒载量< 400拷贝/ml）的有效性。此外，我们还将研究“保留诊所”在以下方面的功效：a）增加艾滋病毒护理就诊人数; B）增加对艾滋病毒治疗方案的依从性; c）增加药物滥用治疗的就诊人数; d）减少药物使用。拟议的方法将代表第一个随机对照试验的综合物质使用和患者导航与艾滋病毒初级保健的这一人群。这项研究也是创新的，因为没有经过验证的干预策略，解决艾滋病毒阳性快克可卡因使用者的艾滋病毒护理保留。这项研究代表了迈阿密大学艾滋病研究发展中心和埃默里大学艾滋病研究中心的合作。在过去的十年中，这两个中心一直在艾滋病毒预防和艾滋病毒感染吸毒者获得护理的相关问题上进行合作。