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
基本信息
- 批准号:9535270
- 负责人:
- 金额:$ 71.74万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AcademyAcquired Immunodeficiency SyndromeAdolescentAdolescent and Young AdultAdoptionAdultAdvisory CommitteesAffordable Care ActAlcohol or Other Drugs useAmericanBehaviorBehavioralCD4 Lymphocyte CountCaringCenters for Disease Control and Prevention (U.S.)CitiesCommunitiesComputerized Medical RecordCounselingCountyDataData AnalysesDocumentationDropsEarly DiagnosisEarly identificationEducationEffectivenessElectronic Health RecordEvaluationFundingFutureGuidelinesHIVHIV InfectionsHIV SeropositivityHIV riskHealthHealthcareHigh PrevalenceHigh School StudentHuman ResourcesHuman immunodeficiency virus testIncidenceIndividualInfectionInterventionInterviewLawsLinkMaintenanceManualsMedicalMedical centerModelingNamesNew YorkNewly DiagnosedPatientsPediatricsPerformancePeriodicityPersonsPhasePopulationPrevalencePreventionPreventivePreventive carePreventive servicePreventive treatmentProviderReminder SystemsReproductive HealthResearchRiskRisk BehaviorsRisk FactorsSafe SexSamplingSchoolsSecureServicesSexual TransmissionSourceStudentsSystemTarget PopulationsTest ResultTestingTimeTrainingTrustUnited StatesViral Load resultVisitWorkYouthagedbasecohorteffective interventionhealth care settingshigh riskhigh risk behaviorhigh schoolimprovedjunior high schoolmotivational enhancement therapymulti-component interventionoutreachpeerpreventprogramspublic health relevancereduced substance useroutine screeningscale upschool healthscreeningsubstance abuse preventiontransmission processuptake
项目摘要
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):疾病预防控制中心要求在卫生保健机构为13岁以上的青少年提供艾滋病毒检测;不幸的是,只有一小部分青少年接受检测。与成年人相比,在艾滋病毒治疗级联的所有步骤中,青年人辍学的比例更大。因此,虽然全国艾滋病毒发病率相对稳定,但年轻人中新感染艾滋病毒的比率正在上升。我们建议调整、实施和评估一项多层次、多组成部分的干预措施,以增加每年例行艾滋病毒检测的接受率,并为高危青年提供更频繁的检测。目标人群是布朗克斯、纽约和该州艾滋病毒流行率最高的县的2所初中和28所高中的青少年。该干预措施将在Montefiore学校健康计划的学校健康中心(SBHC)实施,该中心已经在学校提供艾滋病毒检测。与国家数据一致,对Montefiore电子病历数据的分析证实,艾滋病毒检测的接受率很低。虽然我们需要有效的策略来增加普遍的艾滋病毒检测,但我们的数据表明,大约40%的布朗克斯青年处于艾滋病毒感染的高风险之中。我们还建议为这些青少年提供每两年一次的艾滋病毒检测,并正式提供咨询以减少高危行为。具体目标是:(2)通过每年和紧急访问的筛查,确定SBHC中感染艾滋病毒风险高的青年,并让他们参加每年两次的检测以及安全性行为和药物使用咨询;(3)通过将使用SBHC的青年人数从36%增加一倍,对目前未获得服务的青年实施艾滋病毒普遍和频繁的干预措施占学生总数的72%。拟议的干预措施包括(1)系统一级的举措(一名执行教练、高风险筛查、艾滋病毒检测的实践工作流程、重复艾滋病毒检测的系统提醒);(2)提供者一级的举措(成功提供艾滋病毒检测的培训,艾滋病毒检测动机访谈的培训和降低艾滋病毒风险);(3)基层举措(提供者个性化咨询,为高危青少年提供4次动机访谈方案,以促进更安全的性行为和防止药物滥用);以及(4)实施举措,将覆盖面扩大到更多的青少年(同伴外展;关于SBHC的校本信息;关于SBHC的课堂教育会议,学校工作人员的信息会议)。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规模)。三个随机选择的SBHC将首先实施该计划,然后是三个“延迟控制”中心。6个SBHC现在为9 000多名青年提供服务。项目结束时,所有拟议的干预措施都将是可持续的。将通过从多个来源收集数据,包括对随机抽样的学生班级进行全校评估,使用SBHC与学生进行离职面谈,提供者面谈和包括艾滋病毒检测结果在内的电子医疗记录,在覆盖范围,采用,实施/忠诚度,有效性,维护和可持续性方面对干预措施进行评估。
项目成果
期刊论文数量(0)
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科研奖励数量(0)
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Neal Hoffman其他文献
Neal Hoffman的其他文献
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{{ truncateString('Neal Hoffman', 18)}}的其他基金
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 - 财政年份:2015
- 资助金额:
$ 71.74万 - 项目类别:
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:
9054346 - 财政年份:2015
- 资助金额:
$ 71.74万 - 项目类别:
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