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

项目总结 包括耻辱在内的各种障碍可以限制艾滋病毒携带者获得艾滋病毒和使用药物 注射毒品。接受和承诺治疗(ACT)使这些人能够应对 耻辱和其他护理障碍，导致卫生服务利用率增加。行为是一种 循证干预，使用接受、正念和行为改变过程来 提高心理灵活性。在SCRIPT随机对照试验中，我们显示ACT 可以增加抗逆转录病毒治疗(ART)的启动和人们对物质使用的关注 与艾滋病毒和主动注射吸毒有关。这项研究招募了社区伤害的参与者 减少地点和训练有素的心理学家在社区诊所进行干预，但 尚未研究社区参与的执行战略。实施策略 对于循证护理，对艾滋病毒携带者和注射吸毒者的干预措施很少见。 该项目将缩小这一差距，评估适当的执行成果及其关系。 以及试验结果。我们还将探索实施策略，以在未来的混合动力中进行测试 有效性--ACT的实施试验。使用脚本中现有的混合方法数据 试行，本R03建议评估实施结果并确定实施战略 (包括干预适应、培训、保真度监测)。这个项目的结果将有助于 为被污名化的艾滋病毒携带者注射毒品和 为未来的试验奠定基础，测试基于验收的方法以改善护理获取 对于艾滋病毒携带者，药物使用和潜在的其他污名化疾病。

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.