Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE)

项目概要：本申请的主要目的是研究临床综合社区的效果 卫生工作者（CHW）对艾滋病毒管理不善的黑人艾滋病毒结果的干预。迈阿密戴德 县，佛罗里达，是一个艾滋病毒的震中，黑人成年人占人口的17%和艾滋病的64%- 相关死亡。这些健康差异源于健康的社会决定因素（SDOH），即可改变的 人们成长、生活、工作和变老的环境。在黑人中，负面的SDOH限制了医疗保健 获取和助长种族不平等。在迈阿密戴德，黑人占无家可归者的60%， 生活在联邦贫困线以下的可能性增加了两倍多，失业的可能性增加了三倍 与非黑人相比。这些差距突出表明，迫切需要采取多层次的干预措施 以减轻SDOH对这一人群的影响。因此，本申请旨在审查 CHW干预对SDOH和系统层面因素对HIV结果的影响的影响。 15年来，迈阿密大学一直支持CHW干预措施减少艾滋病毒的研究 差距。我们早期的研究发现，黑人PLH随机接受基于社区的CHW支持， 与接受标准HIV护理的人相比，在6个月内提高了病毒抑制率。进一步研究发现， 基于社区卫生工作者的支持也改善了黑人艾滋病毒携带者的艾滋病毒防治结果。扩展这项工作，这项应用 建议通过将社区卫生工作者纳入艾滋病毒临床治疗， 迈阿密-戴德最大的公共卫生系统中的团队。可行性研究（1 R56 NR 019755 -01） 利益相关者对CHW诊所整合和数据输入被用于开发基于诊所的CHW干预， 将护理延伸到社区环境。由于这项工作发生在大流行期间， 对新出现的医疗保健挑战的看法和潜在的应对CHW支持策略。 治疗依从性、咨询和研究综合导航服务（Integrated Navigation Services for Treatment Adherence，Counseling，and Research）将 将接受过动机访谈培训社区卫生工作者安插到艾滋病毒临床护理团队中，以解决系统一级的SDOH问题 影响因素及个体自我照顾行为的因素。采用随机对照试验设计， 参与者将接受为期12个月的CHW干预或常规HIV护理。三分之一的黑人 从加勒比移民，CHW将接受强大的培训，以利用与黑加勒比的MI战略 亚群干预对艾滋病病毒载量、药物依从性、住院和自我效能的影响 12个月时的治疗依从性将根据医疗记录、受试者跟踪数据和预处理结果确定。 后评估。亚组分析将比较非裔美国人、加勒比人和 黑人和LGBTQ参与者。结果将有助于了解临床和社区的效用， 以社区卫生工作者为基础，改善黑人艾滋病毒感染者的艾滋病毒治疗结果。如果成功优化艾滋病毒健康结果， 这项研究可以为减少这一人口的其他健康差距作出实质性贡献。

Project Summary: The primary aim of this application is to examine the effects of a clinic-integrated community health worker (CHW) intervention on HIV outcomes among Black people with poorly managed HIV. Miami-Dade County, Florida, is an HIV epicenter where Black adults account for 17% of the population and 64% of AIDS- related deaths. These health disparities arise from the Social Determinants of Health (SDOH), the modifiable circumstances in which people grow, live, work, and age. Among Black people, negative SDOH limit healthcare access and foster racial inequities. In Miami-Dade, Black people account for ~60% of the homeless, are more than twice as likely to live below the federal poverty level, and three times more likely to be unemployed compared to the non-Black population. These disparities highlight the critical need for multi-level interventions that ameliorate the impact of the SDOH on this population. Accordingly, this application aims to examine the effects of the CHW intervention on the impact of the SDOH and system-level factors on HIV outcomes. For over 15 years, the University of Miami has supported research on CHW interventions to reduce HIV disparities. Our earlier work found Black PLH randomized to receive community based CHW support for 12 months improved rates of viral suppression vs. those receiving standard HIV care. Further research found clinic based CHW support also led to improved HIV outcomes among Black PLH. Expanding this work, this application proposes to broaden CHW support to both community and clinical settings by integrating CHWs into HIV clinical teams within Miami-Dade’s largest public health system. Feasibility research (1R56NR019755-01) elicited stakeholder input on CHW clinic integration and data was used to develop a clinic-based CHW intervention that extends care to community settings. As this work occurred during the pandemic, stakeholders were also queried on perceptions of emerging healthcare challenges and potentially responsive CHW support strategies. Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE) will embed CHWs trained in motivational interviewing into HIV clinical care teams to address SDOH, system-level factors, and individual self-care behaviors among 300 Black PLH. Using a randomized controlled trial design, participants will receive a 12-month CHW intervention or usual HIV care. As 1 in 3 local Black persons emigrated from the Caribbean, CHWs will receive robust training to utilize MI strategies with Black Caribbean subpopulations. Intervention effects on viral load, medication adherence, hospitalizations, and self-efficacy in treatment adherence at 12 months will be determined from medical records, participant tracking data and pre and post assessments. Subgroup analyses will compare outcomes between African American, Caribbean- Blacks, and LGBTQ participants. Results will contribute to knowledge on the utility of clinic- and community- based CHWs to improve HIV outcomes among Black PLH. If successful in optimizing HIV health outcomes, this research could make a substantive contribution towards reducing other health disparities in this population.