Enhanced Access to HIV Care for Drug Users in San Juan, Puerto Rico

波多黎各圣胡安吸毒者获得更多艾滋病毒护理

• 批准号: 8608514
• 负责人: Lisa R Metsch
• 金额: $ 214.4万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-02-01 至 2018-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8608514
• 关键词: AIDS/HIV problem; Address; Adherence; Affect; Alcohol or Other Drugs use; Alcohols; Anti-Retroviral Agents; Attention; Behavioral; Biological; Caring; Communities; Comorbidity; Diagnosis; Drops; Drug usage; Drug user; Early identification; Effectiveness; Ensure; Environment; Epidemic; Evaluation; Face; Failure; Food; Geographic state; Goals; HIV; HIV Seropositivity; Harm Reduction; Health; Health Services; Health Services Accessibility; Human immunodeficiency virus test; Improve Access; Incidence; Individual; Infection; Injecting drug user; Injection of therapeutic agent; Interdisciplinary Study; Interpersonal Violence; Intervention; Knowledge; Legal; Life; Link; Mental Health; Modeling; Morbidity - disease rate; Neighborhoods; Outcome; Patients; Persons; Pharmaceutical Preparations; Population; Poverty; Primary Health Care; Process; Psyche structure; Psychiatric Social Work; Public Health; Puerto Rico; Quality of life; Randomized; Recording of previous events; Research; Scientific Advances and Accomplishments; Services; Structure; Substance Use Disorder; Testing; Translating; Treatment Protocols; United States; Visit; antiretroviral therapy; cohort; cost; cost effectiveness; design; health care service utilization; health inequalities; heuristics; housing instability; immune function; improved; injection drug use; innovation; mHealth; prevent; primary outcome; public health relevance; screening; secondary outcome; social; success; therapy adherence; transmission process; uptake

DESCRIPTION (provided by applicant): Recent scientific advances demonstrate that for people living with HIV, antiretroviral therapy (ART) is the most effective strategy to improve immune function, reduce morbidity, improve quality of life, prolong survival, and prevent HIV transmission. Translating this knowledge into practice, however, requires prompt diagnosis and linkage to care, entry into care with timely ART initiation, and engagement in care, support for ART adherence, and retention to promote durable virologic suppression. Addressing failures in the implementation of this cascade of care, often referred to as the "Seek, Test, Treat, and Retain (STTR)" paradigm, is vital to achieving the goals of the National HIV/AIDS strategy in the United States. To date, much of the research and discussion surrounding this strategy has focused on expanding HIV testing to improve the early identification of new cases. There has been less attention focused on linkage to, engagement in, and retention in care. Specifically, little attention has focused on identifying HIV-infected individuals who, despite being aware of their diagnosis, have never been in HIV care, are intermittent users of care, or have dropped out of care. A particularly difficult subpopulation to link to and retain in HIV care are HIV-infected drug users. In Puerto Rico, drug use, especially injection drug use, continues to fuel a fast-growing HIV epidemic. Within this context, the overall goal of our proposed project is to implement and evaluate a community-level, structured approach to enhance HIV care access and retention for drug users in San Juan, Puerto Rico. The proposed intervention will be to: 1) identify drug users living with HIV who either do not know their HIV status and/or are not engaged in HIV care; 2) provide direct HIV care services through a mobile health van; and 3) support identified HIV-infected drug users with patient navigators to enhance their ability to engage in HIV care, to initiate antiretroviral therapy, and maintain adherence to their treatment regimens. We are proposing to evaluate our structural enhanced care approach through a randomized roll-out design, a refinement of the stepped-wedge design. The community-level success of the intervention will be assessed by evaluating virologic suppression (primary biological outcome), increased attendance to HIV care visits, uptake of antiretroviral therapy, adherence to HIV treatment regimens, and decreased substance use (as secondary behavioral outcomes) in an independent cohort of HIV-positive individuals drawn from each of the neighborhoods included in the intervention. We will also evaluate the implementation process and cost of the enhanced care approach including implications for cost-effectiveness, feasibility of expansion, and sustainability.

描述（由申请人提供）：最近的科学进展表明，对于艾滋病毒感染者来说，抗逆转录病毒治疗（ART）是改善免疫功能、降低发病率、提高生活质量、延长生存期和预防艾滋病毒传播的最有效策略。然而，将这些知识转化为实践需要及时诊断并与护理联系起来，进入护理并及时启动 ART，并参与护理，支持 ART 依从性，并保留以促进持久的病毒学抑制。解决这种级联护理（通常被称为“寻求、检测、治疗和保留（STTR）”范式）实施中的失败问题对于实现美国国家艾滋病毒/艾滋病战略的目标至关重要。迄今为止，围绕这一策略的大部分研究和讨论都集中在扩大艾滋病毒检测范围，以改善新病例的早期识别。人们对护理的联系、参与和保留的关注较少。具体来说，很少有人关注识别艾滋病毒感染者，尽管他们知道自己的诊断结果，但从未接受过艾滋病毒护理、间歇性接受护理或已经退出护理。感染艾滋病毒的吸毒者是一个特别难以联系并保留在艾滋病毒护理中的亚人群。在波多黎各，吸毒，尤其是注射吸毒，继续助长艾滋病毒流行的快速增长。在此背景下，我们拟议项目的总体目标是实施和评估社区一级的结构化方法，以提高波多黎各圣胡安吸毒者获得艾滋病毒护理的机会和保留率。拟议的干预措施将是： 1) 识别感染艾滋病毒的吸毒者，他们要么不知道自己的艾滋病毒状况和/或没有参与艾滋病毒护理； 2) 通过移动医疗车提供直接的艾滋病毒护理服务； 3) 通过患者导航仪为已确定的 HIV 感染吸毒者提供支持，以增强他们参与 HIV 护理、启动抗逆转录病毒治疗以及坚持治疗方案的能力。我们建议通过随机推出设计（阶梯楔形设计的改进）来评估我们的结构强化护理方法。将通过评估病毒学抑制（主要生物学结果）、增加艾滋病毒护理就诊次数、接受抗逆转录病毒治疗、遵守艾滋病毒治疗方案以及减少物质使用（次要行为结果）来评估干预措施在社区层面的成功程度，该队列来自干预措施所涉及的每个社区的艾滋病毒阳性个体独立队列。我们还将评估强化护理方法的实施过程和成本，包括对成本效益、扩展可行性和可持续性的影响。