Project CONNECT: Connecticut Public Health Partnerships - Promoting Continuity o

描述(由申请人提供)：艾滋病毒连续护理模式建议将艾滋病毒/艾滋病患者(PLH)在医疗保健系统中的参与描述为特征。只有28%的美国PLH实现了病毒抑制，但近一半(49.1%)的PLH基于无效的联系(23%)和保留在护理中(33.7%)而脱离了护理(OOC)。在康涅狄格州，10,849例流行病例中约33%被认为是OOC，定义为在过去一年中没有PVL或CD4,2012年348例新诊断病例中，83%和93%分别在3个月和12个月内与艾滋病毒有关。指南强烈建议“对新确诊患者的成功进入护理和与监测方法、医疗记录和临床数据库等数据来源的使用有关的患者的留存进行系统监测”。实现系统监测一直是一个问题，因为对联系和护理保留的定义各不相同，其中包括来自电子病历(EMR)和/或实验室监测数据(CD4/PVL)的诊所就诊。初步研究表明，可以利用与急救人员相结合的监测数据来改善艾滋病毒医疗护理中的联系和保留。这种方法的障碍包括与共享机密信息有关的限制性州法律、缺乏提供者支持以及患者对入侵和胁迫的看法。为了改善护理方面的联系和重新参与，我们提出了Project CONNECT，这是DPH和CT 93%的HIV治疗地点(Ryan White A诊所(N=19)、选定的私人诊所(N=4)和耶鲁大学医学院)之间的一种新的CT合作伙伴关系。这个新的多学科团队将创建一个名为CTLink的新的创新数据监测系统，该系统将整合3个独立的数据库：eHARS监测数据库、临床和行政预约数据库以及增强的Ryan White CAREWare数据库。它将有能力更准确地定义那些真正脱离护理的人，并报告医疗保健参与度的标准化衡量标准。循证干预(EBI)将包括称为ARTAS+的经过调整的ARTAS II干预措施(抗逆转录病毒治疗和获得服务，一种基于5个疗程优势的病例管理方法)。ARTAS+将适应DPH疾病干预专家(DIS)的工作人员；它将利用移动媒体和我们在瑞安·怀特内部现有密集外展计划的优势。它通过增加一个基于代金券的彩票系统，为有联系但不保留在护理中的个人提供潜在的增强。项目CONNECT具有很高的创新性，这归功于强大的现有合作，创建了将监测和临床护理活动联系起来的全面CTLink数据库，使用了经过调整以达到有效和成本效益的EBI，使用了适应性研究设计和研究伙伴，这些合作伙伴具有长期的多站点合作历史，包括与疾病预防控制中心的合作，以及在出版和传播他们的研究结果方面的良好记录。

DESCRIPTION (provided by applicant): The HIV Continuum of Care Model proposes to characterize the engagement of persons living with HIV/AIDS (PLH) within healthcare systems. Only 28% of U.S. PLH have achieved viral suppression, but nearly half (49.1%) of PLH are out-of-care (OOC), based on ineffective linkage (23%) and retention in care (33.7%). In Connecticut, ~33% of 10,849 prevalent cases are believed to be OOC, defined as not having a pVL or CD4 in the past year and 83% and 93% of the 348 newly diagnosed cases in 2012 were linked to HIV within 3 and 12 months, respectively. Guidelines strongly recommend "systematic monitoring of successful entry into care for newly diagnosed individuals and retention in care for those who are linked with use of data sources including surveillance methods, medical records and clinic databases". Achieving systematic monitoring has been problematic due to varying definitions for linkage and retention in care that include clinic visits from electronic medical records (EMR) and/or laboratory surveillance data (CD4/pVL). Pilot studies suggest that surveillance data integrated with EMRs can be leveraged to improve linkage and retention in HIV medical care. Barriers to this approach include restrictive state laws related to sharing of confidential information, lack of provider support and patient perceptions of intrusion and coercion. To improve linkage and re-engagement in care, we propose Project CONNECT, a new CT partnership between the DPH and 93% of CT's HIV treatment sites (Ryan White A clinics (N=19), selected private clinics (N=4) and Yale University School of Medicine). This new multi-disciplinary team will create a new and innovative data monitoring system called CTLink which will integrate 3 independent databases: the eHARS surveillance database, clinical and administrative appointment databases, and an enhanced Ryan White CAREWare database. It will have capacity to more accurately define those who are truly out of care and report standardized measures of healthcare engagement. Evidence-based interventions (EBIs) will include an adapted ARTAS II intervention (Anti-Retroviral Treatment and Access to Services, a 5-session strengths-based case management approach) called ARTAS+. ARTAS+ will be adapted to DPH Disease Intervention Specialist (DIS) workers; it will harness mobile media and the strengths of our existing intensive outreach programs within Ryan White. It provides potential augmentation by adding a voucher-based lottery system for individuals who are linked, but not retained in care. Project CONNECT is highly innovative due to strong existing collaborations, creation of the comprehensive CTLink database that links surveillance and clinical care activities, use of EBIs that are adapted to be effective and cost-effective, the use f an adaptive study design and research partners with long-standing history of multi-site collaborations, including with the CDC, and a strong track record of publishing and disseminating their findings.