Ending the HIV Epidemic: Peer-supported collaborative care for mental health and substance use disorder care integration into HIV care settings

项目摘要 尽管抗逆转录病毒药物对抑制艾滋病毒有效，但同时患有 精神健康和/或物质使用障碍在艾滋病毒抑制率和保留率方面存在差异， 艾滋病毒护理。精神健康障碍（MHD）和物质使用障碍（SUD）的循证治疗， 包括使用药物和自我管理支持， 艾滋病护理。然而，许多艾滋病毒护理机构的一个关键差距是无法始终如一地进行筛查和提供 治疗MHD/SUD。障碍包括医疗服务提供者对MHD/SUD筛查的了解和舒适度有限 时间限制;以及缺乏辅助人员来促进MHD/SUD的联系和保留 在乎我们提出了一个混合1型实施效果试验的适应协作护理 以同行专家为护理管理者的模式，以加强MHD/SUD的筛查和治疗， 从而提高艾滋病毒抑制率和艾滋病毒诊所的护理参与率。 协作护理（CC），使用护理经理/团队来促进和协调心理整合 卫生和药物使用服务与初级保健相结合，是一个行之有效的循证模式。我们打算 通过培训和支持同行专家作为护理管理者来适应CC。我们将严格 评估同伴支持的CC作为多学科团队的一个组成部分，包括艾滋病毒护理提供者和 成瘾精神病学顾问作为MHD/SUD筛查和治疗的实施策略， 艾滋病护理的连续性。我们将比较这种同行支持的CC常规护理（UC）转介到精神科 护理或SUD治疗计划在初级保健提供者的判断，并评估 使用RE-AIM框架的实施过程。我们的具体目标如下 具体目标1：在一项随机试验中，比较MHD/SUD伴HIV患者的比例 抑制随机分配到协作护理（CC）和常规护理（UC）转诊策略。我们将 将400例患者按1：1随机分为CC组和UC组，并比较HIV抑制患者的比例 （定义为HIV RNA <200拷贝/ml）。 具体目标2：描述CC实施的过程，包括覆盖范围、采用率、保真度和 供应商的可接受性、随时间的维护以及与方法相关的成本。我们提出了一个 混合方法的方法来衡量实施过程的指导下，RE-AIM框架。以南 目标2b，我们将对对等支持的CC模式进行成本分析。 具体目标3：确定CC干预对HIV病毒载量抑制的介质， 保持护理。我们将利用结构化问卷和临床数据来评估CC的介质 对艾滋病毒结果进行干预，并对同伴支持的CC模式的总体经验进行定性评估 并探索患者特征是否影响体验。

Project Abstract Despite the effectiveness of antiretroviral medications for HIV suppression, people with HIV who also have mental health and or substance use disorders suffer disparities in rates of HIV suppression and retention in HIV care. Evidence based treatment for mental health disorders (MHD) and substance use disorders (SUD), including use of medications and self-management support have been associated with improved engagement in HIV care. However, a key gap in many HIV care settings is an inability to consistently screen and provide treatment for MHD/SUD. Barriers include limited provider knowledge of, and comfort with, MHD/SUD screening and treatment; time constraints; and absence of support staff to facilitate linkage and retention in MHD/SUD care. We propose a Hybrid Type 1 implementation- effectiveness trial of an adapted collaborative care model with peer-specialists as care managers, to enhance screening and treatment for MHD/SUD with resultant improvement in rates of HIV viral suppression and care engagement in an HIV clinic setting. Collaborative care (CC), the use of a care manager/team to facilitate and coordinate integration of mental health and substance use services with primary care, is a well-established evidence-based model. We intend to adapt CC by training and supporting peer specialist to function as care managers. We will then rigorously evaluate peer-supported CC as a component of a multidisciplinary team including the HIV care provider and an addiction psychiatry consultant as an implementation strategy for MHD/SUD screening and treatment in a continuity HIV care practice. We will compare this peer-supported CC to usual care (UC) referral to psychiatric care or a SUD treatment program at the discretion of the primary care provider and evaluate the implementation process using the RE-AIM framework. Our specific aims are as follows Specific Aim 1: In a randomized trial, compare the proportion of patients with MHD/SUD with HIV suppression randomized to the collaborative care (CC) and the usual care (UC) referral strategy. We will randomize 400 patients 1:1 to CC versus UC and compare the proportion of patients with HIV suppression (defined as HIV RNA <200 copies/ml) at 12 months. Specific Aim 2: Characterize processes of CC implementation including reach, adoption, fidelity, and provider acceptability, maintenance over time, and costs associated with the approach. We propose a mixed methods approach to measure the implementation processes guided by the RE-AIM Framework. In sub Aim 2b, we will conduct a cost analysis for the peer-supported CC model. Specific Aim 3: Determine the mediators of the CC intervention on HIV viral load suppression and retention in care. We will utilize a structured questionnaire and clinical data to assess mediators of the CC intervention on HIV outcomes and qualitatively assess overall experiences with the peer supported CC model and explore if patient characteristics impact experience.