University of Washington Developmental AIDS Research Center for Mental Health (UW ARCH)

华盛顿大学心理健康发展艾滋病研究中心 (UW ARCH)

• 批准号: 10816853
• 负责人: Jane M. Simoni
• 金额: $ 24.25万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10816853
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; Anti-Retroviral Agents; Assessment tool; Awareness; Caring; Clinical; Communities; Complex; Development; Diagnosis; Dropout; Drops; Drug Screening; Drug usage; Ensure; Environment; Exploration, Preparation, Implementation, and Sustainment; Face; Feedback; Focus Groups; Follow-Up Studies; Fright; General Population; Glass; Goals; HIV; HIV risk; Health; Health Services; Health protection; Imprisonment; Individual; Injections; Intake; Interview; Intoxication; Jail; Justice; Leadership; Legal; Link; Measures; Medical; Modeling; Opioid; Overdose; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Phase; Physicians; Population; Preparation; Prevalence; Prisons; Provider; Public Health; Questionnaire Designs; Recording of previous events; Research; Research Personnel; Resource-limited setting; Risk; Risk Assessment; Risk Behaviors; Risk Factors; Safety; Scientist; Screening procedure; Series; Services; System; Texas; Time; Toxicology; Universities; Unsafe Sex; Urine; Viral; Washington; Withdrawal; Work; addiction; behavioral health; care systems; community based care; community setting; diagnostic tool; disorder risk; effectiveness/implementation trial; evidence base; experience; health assessment; high risk; human centered design; implementation facilitators; implementation science; implementation strategy; improved; injection drug use; instrument; medication for opioid use disorder; mental health center; mortality; opioid overdose; opioid use; opioid use disorder; prevention service; primary care practice; prison population; programs; routine practice; routine screening; screening; social stigma; stakeholder perspectives; substance use; substance use treatment; tool; transmission process; treatment services

PROJECT SUMMARY/ABSTRACT People with HIV who are releasing from prison are at elevated risk of dropping out of HIV care, transmission of HIV to others, and mortality, specifically mortality due to drug overdose. Opioid use disorder (OUD) is a preventable risk factor for poor linkage to community-based HIV care, nonadherence to antiretrovirals, HIV transmission, and overdose after release from prison. Medication for OUD (MOUD) decreases HIV risk behaviors, opioid use, and overdose and is now available in many prisons, including Washington state prisons. Determining whether people have OUD is necessary to ensure that the appropriate patients initiate MOUD and link to addiction services upon release. Identification of people with OUD, however, is complex in the prison setting. Few OUD assessment tools are validated in justice-involved populations, and those that exist are not necessarily widely implemented. HIV transmission risk assessment could be integrated into OUD assessment, providing a comprehensive picture of risk and ensuring status-appropriate referrals to HIV care or prevention services upon release. We are aware of no HIV risk assessment tools that are widely used in prisons, though community-based instruments are available. Prisons are complex implementation environments, due to stigma of OUD and HIV, understaffing, and a primary focus on public safety not public health; this necessitates an implementation-focused approach to integration of OUD and HIV risk assessment. The goals of this supplement application are to 1) understand the perspectives of key stakeholders on identification of OUD and HIV risk among people in prison and 2) work with Washington prison stakeholders to select appropriate tools for OUD and HIV risk assessment and select and adapt implementation strategies to integrate these tools into routine practice. We will first conduct a total of 45 interviews with three groups of stakeholders: 1) Washington prison staff, 2) incarcerated people, and 3) recently released people with HIV or HIV risk. We will then observe existing prison health assessment practices to identify barriers and facilitators to identifying OUD and HIV risk. Finally, we will convene a focus group (n=12) that will meet four times to select tools for OUD and HIV risk assessment and adapt implementation strategies. This work will be guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework, and the focus groups will build on principles of Human Centered Design. Our experienced interdisciplinary team, led by Dr. Jack (physician- scientist practicing primary care in Washington prisons) and Dr. Hamilton (addiction health researcher with focus in criminal legal populations) will conduct this multi-staged formative study with support from an HIV expert (Dr. Graham), implementation science expert (Dr. Glass) and behavioral health assessment expert (Dr. Bradley) along with feedback from community partners. This formative work will inform a follow-up study to pilot the implementation strategies and validate an OUD assessment tool in prisons.

项目概要/摘要 刚出狱的艾滋病毒感染者退出艾滋病毒护理的风险较高， 艾滋病毒传播给他人以及死亡率，特别是因药物过量导致的死亡率。阿片类药物使用障碍 (OUD) 是与基于社区的艾滋病毒护理联系不良、不遵守 抗逆转录病毒药物、艾滋病毒传播以及出狱后服用过量。 OUD 药物 (MOUD) 减少艾滋病毒风险行为、阿片类药物使用和过量服用，目前许多监狱都可以使用，包括 华盛顿州监狱。确定人们是否患有 OUD 对于确保适当的治疗是必要的 患者在释放后启动 MOUD 并链接至戒瘾服务。然而，对 OUD 患者的识别 监狱环境复杂。很少有 OUD 评估工具在涉及司法的人群中得到验证，并且 现有的措施不一定得到广泛实施。可以整合艾滋病毒传播风险评估 纳入 OUD 评估，提供风险的全面情况并确保将其转介至适当的状态 出院后的艾滋病毒护理或预防服务。我们知道没有广泛使用的艾滋病毒风险评估工具 尽管可以使用基于社区的工具，但仍可在监狱中使用。监狱实施复杂 由于 OUD 和 HIV 的耻辱、人员不足以及主要关注公共安全而非公共 健康;这就需要采取以实施为重点的方法来整合 OUD 和艾滋病毒风险评估。 此补充应用程序的目标是 1) 了解主要利益相关者的观点 识别监狱人员中的 OUD 和 HIV 风险，以及 2) 与华盛顿监狱利益相关者合作， 选择适当的工具进行 OUD 和 HIV 风险评估，并选择和调整实施策略，以 将这些工具融入日常实践中。我们将首先对三组进行总共 45 次访谈 利益相关者：1) 华盛顿监狱工作人员，2) 被监禁者，以及 3) 最近获释的艾滋病毒感染者或感染者 艾滋病毒风险。然后，我们将观察现有的监狱健康评估做法，以确定障碍和促进因素 识别 OUD 和 HIV 风险。最后，我们将召集一个焦点小组（n=12），召开四次会议来选择 OUD 和 HIV 风险评估工具并调整实施策略。这项工作将由 探索、准备、实施和维持（EPIS）框架，焦点小组将建立 以人为本的设计原则。我们经验丰富的跨学科团队，由 Jack 博士（医师- 在华盛顿监狱从事初级保健的科学家）和汉密尔顿博士（成瘾健康研究员， 重点关注刑事法律人群）将在艾滋病毒研究中心的支持下进行这项多阶段的形成性研究 专家（Graham 博士）、实施科学专家（Glass 博士）和行为健康评估专家（Dr. Graham） Bradley）以及社区合作伙伴的反馈。这项形成性工作将为后续研究提供信息 在监狱中试行实施战略并验证 OUD 评估工具。