Community-engaged implementation strategies for acceptance interventions to improve access to care for people with HIV and injection drug use

项目摘要 包括耻辱感在内的各种障碍会限制艾滋病毒感染者获得艾滋病毒和使用药物， 注射毒品接受和承诺治疗（ACT）使这些人能够科普 耻辱和其他保健障碍，导致卫生服务利用率上升。ACT是一个 基于证据的干预，使用接受，正念和行为改变过程， 提高心理灵活性。在BACT随机对照试验中，我们发现ACT 可以增加抗逆转录病毒治疗（ART）的启动和物质使用护理参与的人 感染艾滋病毒和注射毒品的人这项研究招募了参与者在社区为基础的伤害 减少网站和训练有素的心理学家提供了在社区诊所的干预，但 尚未研究社区参与的执行战略。执行战略 为艾滋病毒感染者和注射吸毒者提供循证护理干预措施的情况很少。 本项目将缩小这一差距，评估适当的执行结果及其关系 审判结果。我们还将探讨实施战略，以便在未来的混合动力系统中进行测试。 ACT的有效性实施试验。使用现有的混合方法的数据， 试验，本R03建议评估实施结果并确定实施策略 （包括干预适应、培训、保真度监测）。该项目的成果将有助于 注射毒品的艾滋病毒感染者中受侮辱的人群获得保健服务， 为未来测试基于接受的方法以改善护理可及性的试验提供基础 艾滋病毒感染者、药物使用者和其他可能受到侮辱的人。

PROJECT SUMMARY Various barriers including stigma can limit access to HIV and substance use for people with HIV who inject drugs. Acceptance and Commitment Treatment (ACT) empowers these people to cope with stigma and other care barriers, leading to an increase in health services utilization. ACT is an evidence-based intervention that uses acceptance, mindfulness, and behavior change processes to improve psychological flexibility. In the SCRIPT randomized controlled trial, we showed that ACT could increase antiretroviral therapy (ART) initiation and substance use care engagement for people with HIV and active injection drug use. This study recruited participants at a community-based harm reduction site and trained psychologists delivered the intervention at a community clinic, but community-engaged implementation strategies have not yet been studied. Implementation strategies for evidence-based care access interventions for people with HIV and injection drug use are rare. This project will narrow this gap, assessing appropriate implementation outcomes and their relations with trial outcomes. We will also explore implementation strategies, to be tested in future hybrid effectiveness-implementation trials of ACT. Using the existing mixed-methods data from the SCRIPT trial, this R03 proposes to assess implementation outcomes and identify implementation strategies (including intervention adaptation, training, fidelity monitoring). The results from this project will aid in access to health services for the stigmatized population of people with HIV who inject drugs and provide the groundwork for future trials testing acceptance-based approaches to improve care access for people with HIV, substance use and potentially other stigmatized conditions.