Advance Care Coordination and Enhanced Linkage and Retention Among Transitional Re-Entrants Living with Hepatitis C-The HCV-ACCELERATE Trial

丙型肝炎过渡性重新进入者之间的预先护理协调以及增强的联系和保留 - HCV-ACCELERATE 试验

• 批准号: 9386036
• 负责人: Matthew Akiyama
• 金额: $ 18.47万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE, INC
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-15 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9386036
• 关键词: Achievement; Address; Admission activity; Adverse effects; Aftercare; Antiviral Agents; Applications Grants; Appointment; Appointments and Schedules; Award; Behavior Therapy; Caring; Cause of Death; Cirrhosis; Clinical Investigator; Cluster Analysis; Communities; Counseling; Criminal Justice; Data Analyses; Development; Discharge Plannings; Drug usage; Education; Effectiveness; Effectiveness of Interventions; Elements; Ensure; Epidemic; Foundations; Funding; Future; Goals; HIV; Health; Health Personnel; Health Transition; Healthcare; Hepatitis C; Hepatitis C Prevalence; Hepatitis C Transmission; Hospitalization; Imprisonment; Individual; Intervention; Interview; Jail; Knowledge; Lead; Length of Stay; Link; Logistics; Measures; Medical; Mentors; Mentorship; Morbidity - disease rate; Motivation; Needs Assessment; New York City; Outcome; Patient risk; Patients; Phase; Phonation; Population; Prevalence; Primary carcinoma of the liver cells; Prisons; Process Measure; Prospective Studies; Provider; Public Health; Randomized; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Risk Behaviors; Site; Social support; Statistical Data Interpretation; Structure; Substance Use Disorder; System; Telephone; Testing; Time; Training; Treatment outcome; United States; Visit; arm; base; career; career development; design; efficacy testing; experience; health care service utilization; health knowledge; high risk; improved; innovation; longitudinal analysis; mortality; peer; peer coaching; pilot trial; programs; public health intervention; randomized trial; research and development; response; skills; social cognitive theory; standard of care; virology

ABSTRACT The overarching goal of this research is to develop and test an innovative strategy to improve linkage to and retention in hepatitis C virus (HCV) treatment among individuals recently released from jail. Dr. Matthew Akiyama is proposing a K99/R00 career development and research plan which will prepare him to develop interventions to improve linkage to and retention in HCV care among individuals with criminal justice system involvement. HCV is the leading cause of cirrhosis and hepatocellular carcinoma in the United States and, as of 2007, superseded HIV as a cause of death. A strong interrelationship with substance use disorders has led to epidemic proportions of HCV in correctional settings, with a prevalence of 17.4% compared with a national HCV prevalence of only 1.3%. Care coordination programs improve linkage to care among HIV+ individuals leaving correctional settings, yet no prospective studies have evaluated the strategy of care coordination for HCV+ individuals leaving correctional settings. In addition, while peers have been used in diverse settings to address barriers to medical care and are effective at increasing health knowledge, reducing risk behaviors, and facilitating linkage to health care, peer interventions have not been studied for HCV+ individuals leaving correctional settings. Dr. Akiyama has been a key contributor to the development of a care coordination intervention for improving linkage to HCV treatment that is currently underway in the New York City jail system. This proposal builds on this experience and extends it in several important ways. The goal of the mentored (K99) phase of this proposal is to provide Dr. Akiyama with sufficient training in four key skills: 1) advanced qualitative/mixed methods research, 2) developing behavioral interventions, 3) design and conduct of randomized controlled trials in correctional settings, and 4) statistical analysis of longitudinal and clustered data specific to criminal justice populations. During the mentored (K99) phase of the award we will achieve the following specific aims: 1) To identify barriers to and facilitators of linkage to care in an existing HCV care coordination program and 2) To use the barriers and facilitators identified in Aim 1 to design an enhanced, tailored, care coordination intervention with peers as a central component. In the independent R00 phase of the award, we will 3) test the feasibility and effectiveness of the peer- enhanced, tailored, care coordination intervention using a randomized design. We hypothesize that the tailored intervention, enhanced by peers, will lead to greater rates of linkage to HCV treatment, treatment initiation, treatment completion, sustained virologic response, and lower rates of HCV risk behavior. Completion of the proposed pilot trial during the R00 phase along with intensive mentorship during the K99 phase will prepare Dr. Akiyama to test the peer-enhanced care coordination intervention in a multisite randomized controlled trial in a future R01. The proposed K99/R00 award will provide training, mentorship, and research experience that will serve as the foundation for Dr. Akiyama's career as an independently funded clinical investigator dedicated to improving health outcomes for HCV+ individuals with criminal justice system involvement.

抽象的 这项研究的总体目标是制定和测试一种创新策略以改善联系 最近从监狱释放的个体中丙型肝炎病毒（HCV）治疗的保留。博士 Matthew Akiyama提出了K99/R00职业发展和研究计划，这将使他为 制定干预措施，以改善刑事司法个人中HCV护理的联系并保留 系统参与。 HCV是美国肝硬化和肝细胞癌的主要原因 并且，截至2007年，取代艾滋病毒作为死亡原因。与物质使用障碍的强烈相互关系 在矫正环境中导致了HCV的流行比例，与A相比，患病率为17.4％ 国家HCV的患病率仅为1.3％。护理协调计划改善了与艾滋病毒+的护理联系 离开惩教环境的个人，但没有前瞻性研究评估护理策略 HCV+个人离开惩教设置的协调。另外，同时已被使用 各种环境以应对医疗障碍，并有效地增加健康知识，减少 风险行为以及促进与医疗保健的联系，尚未研究HCV+的同伴干预措施 个人离开惩教设置。 Akiyama博士一直是护理发展的关键因素 改善纽约目前正在进行的HCV治疗联系的协调干预措施 城市监狱系统。该建议以这种经验为基础，并以几种重要的方式扩展了它。目标 该提案的指导（K99）阶段是为Akiyama博士提供四个关键技能的足够培训：1） 先进的定性/混合方法研究，2）制定行为干预措施，3）设计和进行 矫正设置中的随机对照试验，以及4）纵向和聚类的统计分析 针对刑事司法人口的数据。在奖励的指导阶段（K99）期间，我们将实现 以下具体目的：1）确定与现有HCV中关心的链接障碍和促进者 护理协调计划和2）使用AIM 1中确定的障碍和促进者来设计 增强，量身定制的护理协调干预与同龄人作为中心成分。在 奖励的独立R00阶段，我们将3）测试同行的可行性和有效性 使用随机设计增强，量身定制的护理协调干预。我们假设 量身定制的干预措施通过同伴增强，将导致与HCV治疗的联系率更高 启动，治疗完成，持续的病毒反应以及HCV风险行为的降低。 在R00阶段完成拟议的试点试验以及K99期间的密集指导 阶段将准备Akiyama博士，以测试多站点中的同伴增强的护理协调干预 未来R01中的随机对照试验。拟议的K99/R00奖将提供培训，指导和 研究经验将成为Akiyama博士作为独立资助的职业生涯的基础 致力于改善HCV+患有刑事司法系统的人的健康状况的临床研究者 参与。