Universal for all, frequent for some: HIV testing in school-based health centers

对所有人普遍，对某些人常见：学校卫生中心的艾滋病毒检测

• 批准号: 9317467
• 负责人: Neal Hoffman
• 金额: $ 73万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-15 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9317467
• 关键词: Academy; Acquired Immunodeficiency Syndrome; Adolescent; Adolescent and Young Adult; Adoption; Adult; Advisory Committees; Affordable Care Act; Alcohol or Other Drugs use; American; Behavior; Behavioral; CD4 Lymphocyte Count; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Communities; Computerized Medical Record; Counseling; County; Data; Data Analyses; Documentation; Drops; Early Diagnosis; Early identification; Education; Effectiveness; Electronic Health Record; Evaluation; Funding; Future; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV risk; Health; Healthcare; High Prevalence; High School Student; Human Resources; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Interview; Laws; Link; Maintenance; Manuals; Medical; Medical center; Modeling; Names; New York; Newly Diagnosed; Patients; Pediatrics; Performance; Periodicity; Persons; Phase; Population; Prevalence; Prevention; Preventive; Preventive care; Preventive service; Preventive treatment; Provider; Reminder Systems; Reproductive Health; Research; Risk; Risk Behaviors; Risk Factors; Safe Sex; Sampling; Schools; Secure; Services; Sexual Transmission; Source; Students; System; Target Populations; Test Result; Testing; Time; Training; Trust; United States; Viral Load result; Visit; Work; Youth; aged; base; cohort; effective intervention; high risk; high risk behavior; high school; improved; junior high school; motivational enhancement therapy; multi-component intervention; outreach; peer; prevent; programs; public health relevance; reduced substance use; scale up; school health; screening; substance abuse prevention; transmission process; uptake

 DESCRIPTION (provided by applicant): The CDC requires offering an HIV test in health care settings to adolescents aged >13; unfortunately only a small proportion of youth are tested. Compared to adults, larger proportions of youth drop out at all steps of the HIV treatment cascade. Thus, although HIV incidence nationally is relatively stable, the rate of new HIV infections among young persons is increasing. We propose to adapt, implement, and evaluate a multi-level, multi-component intervention to increase the uptake of routine annual HIV testing and to provide more frequent testing to high-risk youth. The target population is adolescents in 2 middle and 28 high schools in the Bronx, New York, and the county with among the highest HIV prevalence in the state. The intervention will be implemented in school-based health centers (SBHCs) of the Montefiore School Health Program, which already offer HIV testing in schools. Consistent with national data, analysis of Montefiore's electronic medical record data confirms that uptake of HIV testing is low. Although we need effective strategies to increase universal HIV testing, our data suggests that approximately 40% of Bronx youth are at high risk of HIV acquisition. We also propose to offer bi-annual HIV testing for these youth, and to formalize counseling to reduce high risk behavior. The specific aims are: (1) Develop a replicable effective model of universal HIV testing in SBHCs; (2) Identify youth in SBHC at high risk for HIV acquisition through screening at annual and emergent visits and engage them in twice-yearly testing and safer sex and substance use counseling; (3) Implement the HIV universal and frequent interventions with youth not currently served by doubling the number of youth that utilize the SBHCs from 36% to 72% of the student population. The proposed intervention includes (1) system-level initiatives (an Implementation Coach, screening for high risk, practice work flows for HIV testing, system reminders for repeat HIV tests); (2) provider-level initiatives (training to successfully offer an HIV test, training in motivational interviewing for HIV testing nd to reduce HIV risk); (3) adolescent-level initiatives (individualized provider counseling, a 4-session motivational interviewing program for high risk youth to promote safer sex and to prevent substance abuse); and (4) implementation initiatives to expand coverage to more youth (peer outreach; school-based messaging about SBHCs; in-class education sessions about SBHCs, informational sessions for school personnel). Interventions will be implemented in three phases (Universal Testing, Targeted Prevention, and Scale Up). Three randomly selected SBHC will implement the program first, followed by three "delayed control" centers. The 6 SBHC now serve over 9,000 youth. All proposed interventions will be sustainable when the project ends. The interventions will be evaluated in terms of reach, adoption, implementation/fidelity, effectiveness, maintenance, and sustainability by collecting data from multiple sources, including, school-wide assessments of randomly sampled classes of students, exit interviews with students using the SBHC, provider interviews, and electronic medical records which include HIV test results.

 描述(由申请人提供)：疾控中心要求在卫生保健环境中向13岁的青少年提供艾滋病毒检测；不幸的是，只有一小部分年轻人接受了检测。与成年人相比，年轻人在艾滋病毒治疗级联的所有步骤中辍学的比例更大。因此，尽管全国艾滋病毒发病率相对稳定，但年轻人中新的艾滋病毒感染率正在上升。我们建议调整、实施和评估多层次、多成分的干预措施，以增加对艾滋病毒年度常规检测的接受，并为高危青年提供更频繁的检测。目标人群是纽约州布朗克斯区2所初中和28所高中的青少年，以及该州艾滋病毒感染率最高的县之一。这项干预措施将在蒙特菲奥里学校卫生计划的学校卫生中心(SBHC)实施，这些中心已经在学校提供艾滋病毒检测。与国家数据一致，对蒙特菲奥雷电子病历数据的分析证实，艾滋病毒检测的接受率很低。尽管我们需要有效的战略来增加普遍的艾滋病毒检测，但我们的数据表明，大约40%的布朗克斯青年面临感染艾滋病毒的高风险。我们还建议为这些年轻人提供一年两次的艾滋病毒检测，并将咨询正规化，以减少高危行为。具体目标是：(1)制定一种可复制的有效模式，在私营安老院进行普遍的艾滋病毒检测；(2)通过每年和紧急探访时进行筛查，找出安老院感染艾滋病毒的高危青少年，并让他们进行一年两次的检测以及更安全的性行为和药物使用咨询；(3)对目前没有得到服务的年轻人实施普遍和频繁的艾滋病毒干预措施，方法是将使用安老院的青年人数从学生人口的36%增加一倍至72%。拟议的干预措施包括(1)系统一级的举措(一名实施教练、高风险筛查、艾滋病毒检测实践工作流程、艾滋病毒重复检测的系统提醒)；(2)提供者一级的举措(成功提供艾滋病毒检测的培训、艾滋病毒检测的激励面谈培训和降低艾滋病毒风险)；(3)青少年层面的举措(个体化提供者咨询，为高危青年提供的4节激励访谈方案，以促进安全性行为和防止药物滥用)；以及(4)实施举措，以扩大覆盖更多年轻人的范围(同伴外联；以学校为基础的关于SBHC的信息；关于SBHC的课堂教育课程、为学校工作人员举办的信息课程)。干预措施将分三个阶段实施(普遍检测、有针对性的预防和扩大)。随机选择的三个SBHC将首先实施该计划，然后是三个“延迟控制”中心。目前，6家社区卫生服务中心为9000多名青年提供服务。当项目结束时，所有拟议的干预措施都将是可持续的。通过从多种来源收集数据，将从覆盖范围、采用、实施/保真度、有效性、维护和可持续性等方面对干预措施进行评估，这些数据来源包括对随机抽样的学生班级进行的全校评估、使用SBHC对学生进行的离职访谈、提供者访谈以及包括艾滋病毒检测结果的电子医疗记录。