Improving the Integration of Mental Health and Substance Use Treatment into Ryan White-Funded Care Sites in Atlanta using an Implementation Science Approach

项目摘要/摘要 作为对RFA-MH-20-521的响应，该R34应用程序建议采用减少污名的培训，开发 新的处方平台，并试点测试这些实施策略，以提高整合 年瑞安·怀特护理中心严重精神健康障碍和酒精使用障碍(AUD)的药物治疗 结束疫情计划的三个县-亚特兰大大都市区的代卡尔布县、格温内特县和科布县。 我们建议建立一个社区合作委员会(CCB)，其中包括艾滋病毒携带者(PLHIV)和 与PLHIV进行深入访谈，以调整卫生政策项目的减少污名培训，以解决 精神健康和与药物滥用有关的耻辱。我们还将聘请一个由精神病学家和 艾滋病毒医学专家，并与提供者进行焦点小组讨论，以了解 You℞Decision处方平台，该平台将帮助提供者决定是否为以下对象开药 在PLHIV中，抑郁症、创伤后应激障碍、双相情感障碍和AUD。该平台将可通过移动设备访问- 智能手机和平板电脑-并将使用基于艾滋病毒初级保健最佳实践的算法和基于 关于艾滋病毒医学和精神病学专家的反馈意见，以指导艾滋病毒提供者开发最佳 合并症患者的用药方案。对于这笔规划拨款，我们将使用综合 实施研究框架、ERIC建议和Proctor的实施分类 探索实施的决定因素，确定实施战略，并评估 减少耻辱培训并评估You℞决策处方平台在 积极影响健康中心，这是瑞安·怀特资助的护理网站。我们还将进行试点试验，以 评估减少耻辱培训的初步影响，以减少临床层面的耻辱和You℞决定 处方平台，提高提供者与开精神科药物有关的自我效能 纳曲酮(靶向机制)及其对抑郁症、创伤后应激障碍、双相情感障碍、 和AUD(收养)。具体目标：目标1：与艾滋病毒感染者、艾滋病毒护理提供者、 和我们的CCB调整一项减少耻辱的培训，以解决与精神健康和药物滥用有关的问题 诊所工作人员的耻辱，并聘请艾滋病毒护理提供者和一个专家小组来制定You℞决定 支持艾滋病毒护理提供者提供治疗抑郁症、创伤后应激障碍、 双相情感障碍和澳元。目的2：评估临床接受耻辱消除培训的情况 员工和使用You℞决策处方平台的可行性、可接受性和采用率 在艾滋病毒护理环境中的提供者之间的临床接触。目标3：使用具体的方法进行 评估减少污名培训对临床一级污名的初步影响的试点试验 You℞决定开处方平台关于艾滋病护理提供者自我效能开精神科药物的研究 以及纳曲酮的影响以及减少耻辱的培训和平台，以提高百分比 接受治疗抑郁症、创伤后应激障碍、双相情感障碍和AUD处方的合格患者的比例。

PROJECT SUMMARY/ABSTRACT In response to RFA-MH-20-521, this R34 application proposes to adapt a stigma-reduction training, develop a new prescribing platform, and pilot test these implementation strategies to improve the integration of pharmacotherapy for serious mental health disorders and alcohol use disorder (AUD) in Ryan White care sites in three counties of the Ending the Epidemic Plan—Dekalb, Gwinnett, and Cobb Counties in the Atlanta Metro area. We propose to engage a Community Collaborative Board (CCB) that includes people living with HIV (PLHIV) and conduct in-depth interviews with PLHIV to adapt the Health Policy Project's stigma-reduction training to address mental health and substance abuse-related stigma. We also will engage an expert panel of psychiatrists and experts in HIV medicine and conduct focus group discussions with providers to inform the development of the You℞ Decision prescribing platform, which will help providers make decisions about prescribing medications for depression, PTSD, bipolar disorder, and AUD among PLHIV. This platform will be accessible via mobile devices— smartphones and tablets—and will use algorithms based on best practices in HIV primary care and refined based on feedback from experts in HIV medicine and psychiatry to guide HIV providers in developing the best medication regimens for patients with comorbid disorders. For this planning grant, we will use the Consolidated Framework for Implementation Research, the ERIC recommendations, and Proctor's implementation taxonomy to explore the determinants of implementation, identify implementation strategies, and assess the acceptability of the stigma-reduction training and assess feasibility and acceptability of the You℞ Decision prescribing platform in Positive Impact Health Centers, which are Ryan White-funded care sites. We will also conduct a pilot trial to assess the preliminary impact of the stigma-reduction training to reduce clinic-level stigma and the You℞ Decision prescribing platform to increase providers' self-efficacy related to prescribing psychiatric medication and naltrexone (targeted mechanisms) and their provision of pharmacotherapy for depression, PTSD, bipolar disorder, and AUD (adoption). Specific Aims: Aim 1: To conduct formative activities with PLHIV, HIV care providers, and our CCB to adapt a stigma-reduction training to address mental health and substance abuse-related stigma among clinic staff and engage HIV care providers and an expert panel to develop the You℞ Decision prescribing platform to support HIV care providers to offer pharmacotherapy to treat depression, PTSD, bipolar disorder, and AUD. Aim 2: To assess the acceptability of the stigma-reduction training among clinic staff and the feasibility, acceptability, and adoption of using the You℞ Decision prescribing platform during clinical encounters among providers in HIV care settings. Aim 3: To use idiographic methods to conduct a pilot trial to assess the preliminary impact of the stigma-reduction training on clinic-level stigma and of the You℞ Decision prescribing platform on HIV care providers' self-efficacy to prescribe psychiatric medications and naltrexone as well as the impact of the stigma-reduction training and platform to increase the percentage of eligible patients who receive prescriptions to treat depression, PTSD, bipolar disorder, and AUD.