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

治疗依从性、咨询和研究综合导航服务 (INSTACARE)

• 批准号: 10710206
• 负责人: SONJIA KENYA
• 金额: $ 75.63万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10710206
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adult; African American; African American population; African Caribbean; Age; Behavior; Black Populations; Black race; Boston; Caribbean region; Caring; Cessation of life; Clinic; Clinical; Communities; Community Health; Community Health Aides; Computerized Medical Record; Continuity of Patient Care; Counseling; County; Data; Disparity; Emigrations; Enrollment; Exhibits; Florida; Fostering; Goals; HIV; HIV disparities; HIV risk; Health; Health system; Healthcare; Healthcare Systems; Homelessness; Hospitalization; Individual; Intervention; Knowledge; Lesbian Gay Bisexual Transgender Queer; Long-Term Care; Maps; Medical Records; Minority Groups; Modeling; National Institute on Minority Health and Health Disparities; Observational Study; Outcome; Participant; Perception; Persons; Population; Poverty; Pragmatic clinical trial; Public Health; Public Hospitals; Randomized; Randomized, Controlled Trials; Research; Research Support; Risk Behaviors; Sampling; Scientific Advances and Accomplishments; Self Care; Self Efficacy; Social support; Subgroup; System; Testing; Training; Unemployment; Universities; Viral; Viral Load result; Woman; Work; barrier to care; black men; clinical care; community setting; comparison group; disparity reduction; feasibility research; federal poverty level; health assessment; health care availability; health determinants; health disparity; implementation protocol; improved; intervention effect; medication compliance; motivational enhancement therapy; pandemic disease; peer support; psychosocial; racial discrimination; racial disparity; research study; sexual minority; sexual minority group; social; social health determinants; socioeconomics; stem; treatment adherence; treatment as usual; treatment services; trial design

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.

项目摘要：此应用程序的主要目标是检查诊所综合社区的影响 卫生工作者(CHW)对艾滋病毒管理不善的黑人中艾滋病毒结局的干预。迈阿密-戴德 佛罗里达州的县是艾滋病病毒的中心，黑人成年人占总人口的17%，占艾滋病患者的10%。 相关死亡。这些健康差异是由健康的社会决定因素(SDOH)引起的，可修改的 人们成长、生活、工作和变老的环境。在黑人中，SDOH阴性限制了医疗保健 获取和促进种族不平等。在迈阿密-戴德，黑人占无家可归者的60%，比 生活在联邦贫困线以下的可能性是联邦贫困水平的两倍多，失业的可能性是联邦贫困水平的三倍 与非黑人人口相比。这些差距突显了多层次干预的迫切需要 这改善了SDOH对这一人群的影响。因此，此应用程序旨在检查 CHW干预对SDOH和系统水平因素对HIV结局的影响。 15年来，迈阿密大学一直支持CHW干预措施以减少艾滋病毒的研究 差距。我们早期的工作发现Black PLH是随机接受社区CHW支持的12个人 与那些接受标准艾滋病毒护理的人相比，几个月的病毒抑制率有所提高。进一步研究发现临床 基于CHW的支持也导致黑人PLH中艾滋病毒结果的改善。扩展这项工作，这个应用程序 建议通过将CHW整合到HIV临床中，将CHW的支持扩大到社区和临床环境 迈阿密-戴德最大的公共卫生系统内的团队。引发可行性研究(1R56NR019755-01) 利益相关者对CHW临床整合和数据的输入被用来开发基于临床的CHW干预，该干预 将关怀扩展到社区设置。由于这项工作发生在大流行期间，也询问了利益攸关方 对新出现的医疗挑战和潜在的响应CHW支持战略的看法。 治疗依从性、咨询和研究综合导航服务(INSTACARE)将 将经过激励性访谈培训的CHW嵌入HIV临床护理团队，以解决系统级的SDOH问题 300名黑种人自理行为的相关因素分析。采用随机对照试验设计， 参与者将接受为期12个月的CHW干预或常规艾滋病毒护理。1/3的当地黑人 从加勒比海移民过来的CHW将接受强有力的培训，以利用黑人加勒比地区的MI战略 亚群。干预对艾滋病患者病毒载量、服药依从性、住院时间和自我效能的影响 12个月的治疗依从性将根据医疗记录、参与者跟踪数据和 和岗位评估。分组分析将比较非裔美国人、加勒比海人- 黑人和LGBTQ参与者。结果将有助于了解临床和社区的效用- 以CHW为基础，以改善黑人PLH中的艾滋病毒结果。如果在优化艾滋病毒健康成果方面取得成功， 这项研究可以为减少这一人群中的其他健康差距做出实质性贡献。