Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations

通过立即对参与司法的人群进行传染病和阿片类药物使用障碍社区治疗（行动）来解决风险

• 批准号: 10675706
• 负责人: KEVIN KNIGHT
• 金额: $ 266.73万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675706
• 关键词: AIDS prevention; Address; Adherence; Appointment; Caring; Chlamydia; Clinic; Communities; Community Health Aides; Community Healthcare; Community Services; Connecticut; Cost Analysis; County; Criminal Justice; Diagnosis; Disease Management; Drug Prescriptions; Effectiveness; Effectiveness of Interventions; Eligibility Determination; Funding; HIV; HIV Infections; HIV risk; Harm Reduction; Health Personnel; Health Services Accessibility; Hepatitis B Virus; Hepatitis C virus; Hybrids; Imprisonment; Incidence; Individual; Infrastructure; Injecting drug user; Intervention; Jail; Justice; Length; Link; London; Measures; Medical; Methods; Mobile Health Units; Modeling; National Institute of Drug Abuse; Opioid; Outcome; Overdose; Participant; Persons; Pharmaceutical Preparations; Population; Prevention; Prisons; Provider; Randomized; Recording of previous events; Risk; Risk Behaviors; Service delivery model; Services; Sexually Transmitted Diseases; Social Environment; Stimulant; Substance Use Disorder; Supervision; Syphilis; System; Testing; Texas; Time; U-Series Cooperative Agreements; Use Effectiveness; Viral; antiretroviral therapy; behavioral health; care outcomes; care systems; community based service; community organizations; community reentry; compare effectiveness; cost; effective intervention; effectiveness outcome; effectiveness-implementation RCT; evidence base; follow-up; geographic risk; health care service utilization; high risk; implementation framework; implementation outcomes; improved; infectious disease treatment; injection drug use; innovation; insight; medication for opioid use disorder; member; opioid injection; opioid use; opioid use disorder; patient navigation; patient navigator; peer; post intervention; pre-exposure prophylaxis; prevent; prevention service; rapid testing; recruit; response; satisfaction; scale up; screening; secondary outcome; service delivery; service providers; social stigma; stimulant use; treatment services; trial comparing

Project Abstract Improving HIV and Opioid Use Disorder (OUD) management and implementation for criminal justice (CJ)- involved individuals requires effective approaches to screening, linkage and adherence to integrated services across community agencies and service providers. Community reentry represents a critical opportunity to link individuals to HIV prevention and treatment and OUD service providers. In response to RFA DA-20-028, our proposed study called Addressing risk through Community Treatment for Infectious disease and Opioid use disorder Now (ACTION) among justice-involved populations, is a 5-year Hybrid Type 1 Effectiveness- Implementation RCT that compares two models [Patient Navigation (PN) or Mobile Health Unit (MHU) service delivery] of linking individuals recently released from prison and jail to the continuum of community-based HIV and OUD prevention and treatment service cascades of care. A total of 864 CJ-involved individuals who are being released to 2 CT communities (New London and Windham/Tolland Counties) & 2 TX communities (Dallas and Tarrant Counties) with pre-arrest histories of opioid/injection drug use and are living with or at-risk of HIV will be randomized to receive at post-release either: a) a PN system for care, wherein patient navigators will link study participants to community-based service providers during the 6-month post-release intervention period; those without HIV will be provided access to PrEP services, and those living with HIV will receive access to ART services, or b) services delivered via a MHU, wherein study participants will be linked to a MHU within their community where they will receive integrated PrEP/ART, MOUD, harm reduction services on the MHU during the 6 month post-release intervention period. There are 2 specific aims: Aim 1 (Intervention Effectiveness): To compare the effectiveness of the use of PN vs. MHU service delivery on participant length of time to taking initial post-release PrEP (prevention)/ART (treatment) medication within 6 months following release from custody. Secondary outcomes will examine the continuum of PrEP and HIV care outcomes, including (but not limited to) the following additional measures: HIV viral suppression for PLH, PrEP adherence, HIV risk behaviors; HCV measures such as HCV testing & linkage to treatment; sexually transmitted infection (STI) incidence (GC/ Chlamydia/ Syphilis and HBV); and primary medical care appointments. Importantly, we will also assess OUD and SUD-related measures: OUD/ SUD diagnoses, MOUD prescription receipt &retention, opioid & stimulant use, & overdose incidents. Aim 2 (Implementation): To evaluate PN and MHU feasibility, acceptability, and costs. Primary implementation outcomes include feasibility (health care utilization impact among released individuals, contributions of interagency workgroup members on outcomes); acceptability (participant satisfaction, perceived usefulness); sustainment (continued utilization), and costs required to implement and sustain the approaches as well as to scale-up in additional communities. Barriers to service access across the community provider spectrum will be assessed as well.

项目摘要 改进艾滋病毒和阿片类药物使用障碍的管理和刑事司法的实施（CJ）- 参与的个人需要有效的方法来筛选，联系和坚持综合服务 在社区机构和服务提供商之间。重返社区是一个关键的机会， 艾滋病毒预防和治疗以及OUD服务提供者。为了响应RFA DA-20-028，我们的 一项名为“通过社区治疗传染病和阿片类药物使用来解决风险”的拟议研究 在涉及司法的人群中，现在的障碍（行动）是一个5年的混合1型有效性- 比较两种型号[患者导航（PN）或移动的医疗单元（MHU）服务]的实施RCT 将最近从监狱和监狱释放的个人与社区艾滋病毒连续体联系起来 和OUD预防和治疗服务的级联护理。共有864名CJ参与者， 被释放到2个CT社区（新伦敦和温德姆/托兰县）和2个TX社区 （达拉斯和塔兰特县），逮捕前有阿片类药物/注射药物使用史，并且与 的HIV患者将在出院后随机接受：a）用于护理的PN系统，其中患者导航员 将在6个月的释放后干预期间将研究参与者与社区服务提供者联系起来 没有艾滋病毒的人将获得PrEP服务，艾滋病毒感染者将获得 获得ART服务，或B）通过MHU提供的服务，其中研究受试者将与MHU相关联 在他们的社区内，他们将获得综合的PrEP/ART，MOUD， 在6个月的释放后干预期间的MHU。有两个具体目标：目标1（干预 有效性）：比较使用PN与MHU服务对受试者长度的有效性 在以下6个月内使用初始发布后PrEP（预防）/ART（治疗）药物的时间 释放次要结果将检查PrEP和艾滋病毒护理结果的连续性， 包括（但不限于）以下额外措施：HIV病毒抑制PLH，PrEP 依从性、艾滋病毒风险行为; HCV检测等HCV措施以及与治疗的联系;性 传播感染（STI）发病率（GC/衣原体/梅毒和HBV）;和初级医疗保健 约会.重要的是，我们还将评估OUD和SUD相关指标：OUD/ SUD诊断， MOUD处方收据和保留，阿片类药物和兴奋剂使用，以及过量事件。目标2（执行）： 评价PN和MHU的可行性、可接受性和成本。主要实施成果包括 可行性（获释人员的医疗保健利用影响，机构间医疗保健机构的贡献） 成果）;可接受性（参与者满意度、认为有用）;可持续性（续 利用率），以及实施和维持这些方法以及扩大额外的 社区.还将评估社区提供商范围内获得服务的障碍。