Mobile Application to Improve Care Coordination among HIV Clinic and Substance Use Treatment Providers

项目概要/摘要 吸毒与艾滋病毒护理联系不紧密、继续护理减少、性风险增加有关。 行为，并减少对药物的依从性，导致较差的临床结果，并增加艾滋病毒 传输吸毒的艾滋病毒感染者（HPWUD）同时发生精神病和 医疗诊断，从而提高了服务的利用率。许多结构性和系统性障碍阻碍了 艾滋病毒治疗和药物使用的整合（SU）。结合使用移动的应用程序和 循证培训模式为改善护理协调和联系提供了一种创新方法 需要双重治疗的患者。通过平板设备提供的移动健康应用程序提供了一个独特的 一个渠道，将位于非现场诊所的艾滋病毒和SU治疗提供者联系起来。这项研究将是第一阶段的试点， 可行性研究，这将是第一个使用基于理论的护理协调模式，以制定一个护理 协调干预（CCI）为HPWUD提供服务的治疗提供者。拟议研究旨在发展 一个安全的移动的技术平台，该平台将：（a）使多个供应商之间能够快速通信， 诊所，（B）改善与双重护理的联系，（c）改善病人服务的协调。CCI还将 利用循证培训模式，以增加提供者在相关艾滋病毒，PrEP和SU问题方面的知识。 所提出的方法，整合双重护理的病人，预计将是一个有效的，容易 整合艾滋病毒/SU护理的可传播平台，将促进提供者之间的沟通， 多个诊所，并允许有效管理病人的治疗转诊和服务利用。这 项目将使用混合方法检查可接受性、可行性和可持续性潜力。三相， 将采用自上而下的研究方法，对干预措施进行调整、完善和试点测试。第一阶段将 包括与主要利益攸关方的个别访谈，以及对内部转介和沟通过程的审计， 每个诊所第二阶段将包括CCI的开发。我们将进行功能测试， 与关键利益相关者进行一系列访谈，以告知CCI的迭代修订。在第三阶段，我们将训练 提供者在CCI和评估的可行性，可接受性和可持续性的潜力，艾滋病毒和SU 位于两个不同诊所的治疗提供者通过前、后测试设计。数据将在 组织、提供者和患者层面。与两家诊所实施CCI前相比， 预计实施后的数据将导致：（H1）提供者对护理协调的满意度更高 （H2）提高机构间通信的频率和质量;（H3）增强 机构间的专业关系;和（H4）增加双重护理保留在病人的水平。很长的- 长期目标是扩大可持续干预措施的可用性，以改善艾滋病毒和SU的协调 治疗服务。这项研究的数据将构成未来多站点R 01提案的基础， 新的调查员申请人

Project Summary/Abstract Drug use is associated with poor linkages to HIV care, reduced retention in care, increased sexual risk behavior, and decreased adherence to medications, leading to inferior clinical outcomes, and increased HIV transmission. HIV-infected people who use drugs (HPWUD) have higher rates of co-occurring psychiatric and medical diagnoses, resulting in increased utilization of services. Many structural and systemic barriers impede the integration of treatment for HIV and substance use (SU). The use of a mobile application combined with an evidence-based training model offers an innovative approach to improving care coordination and linking patients to care in need of dual treatment. A mhealth application delivered via tablet device provides a unique channel to link HIV and SU treatment providers located at off-site clinics. This study will be a Stage I pilot and feasibility study that will be the first to use a theory-based model of care coordination to develop a Care Coordination Intervention (CCI) for treatment providers serving HPWUD. The proposed study seeks to develop a secure mobile technology platform that will: (a) enable rapid communication among providers at multiple clinics, (b) improve linkage to dual care, and (c) improve coordination of patient services. The CCI will also utilize an evidence-based training model to increase provider knowledge in relevant HIV, PrEP, and SU issues. The proposed method of integrating dual care for patients is expected to be an efficient and easily disseminable platform for integrating HIV/SU care that will facilitate communication between providers at multiple clinics and allow for efficient management of patient treatment referrals and service utilization. This project will examine acceptability, feasibility, and sustainability potential using mixed-methods. A three-phase, top-down research approach to adapt, refine, and pilot test the intervention will be conducted. Phase 1 will include individual interviews with key stakeholders and audits of referral and communication processes within each clinic. Phase 2 will include development of the CCI. We will conduct a functionality test and conduct a series of interviews with key stakeholders to inform iterative revision of the CCI. During Phase 3, we will train providers in the CCI and evaluate the feasibility, acceptability, and sustainability potential among HIV and SU treatment providers located at two different clinics via a pre-, post-test design. Data will be gathered at the organizational-, provider-, and patient-levels. Compared to pre-implementation of the CCI in both clinics, we expect that post-implementation data will result in: (H1) greater satisfaction of care coordination at the provider level; (H2) increased frequency and improved quality of interagency communications; (H3) enhanced interagency professional relationships; and (H4) increased dual care retention at the patient level. The long- term goal is to expand the availability of sustainable interventions to improve coordination of HIV and SU treatment services. Data from this research will form the basis of a future multisite R01 proposal for this early career, new investigator applicant.