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: 10268231
• 负责人: KEVIN KNIGHT
• 金额: $ 266.54万
• 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/10268231
• 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; Navigation System; Opioid; Outcome; Overdose; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Prevention; Prisons; Provider; Randomized; Recording of previous events; Risk; Risk Behaviors; Service delivery model; Services; Sexually Transmitted Diseases; Social Environment; Substance Use Disorder; Supervision; Syphilis; System; Testing; Texas; Time; U-Series Cooperative Agreements; Use Effectiveness; Viral; antiretroviral therapy; base; behavioral health; care outcomes; care systems; community based service; 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; member; opioid injection; opioid use; opioid use disorder; peer; post intervention; pre-exposure prophylaxis; prescription opioid; 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 改善艾滋病毒和阿片类药物使用障碍 (OUD) 的管理和刑事司法 (CJ) 的实施 - 相关个人需要有效的方法来筛选、联系和遵守综合服务 跨社区机构和服务提供商。重新进入社区是建立联系的重要机会 个人向艾滋病毒预防和治疗以及 OUD 服务提供商提供信息。为了回应 RFA DA-20-028，我们 拟议的研究名为“通过社区治疗传染病和阿片类药物来解决风险” 现在（行动）在涉及正义的人群中，是一种为期 5 年的混合 1 型有效性 - 比较两种模型的实施随机对照试验 [患者导航 (PN) 或移动医疗单元 (MHU) 服务 将最近从监狱和监狱释放的个人与社区艾滋病毒的连续性联系起来 OUD 预防和治疗服务级联护理。共有 864 名 CJ 相关人员 正在向 2 个 CT 社区（新伦敦县和 Windham/Tolland 县）和 2 个 TX 社区发布 （达拉斯县和塔兰特县）逮捕前有阿片类药物/注射毒品使用史，并且患有或面临风险 HIV 患者将在出院后随机接受： a) PN 护理系统，其中患者导航员 在释放后 6 个月的干预期间，将把研究参与者与社区服务提供者联系起来 时期;没有艾滋病毒的人将获得 PrEP 服务，而感染艾滋病毒的人将获得 获得 ART 服务，或 b) 通过 MHU 提供的服务，其中研究参与者将链接到 MHU 在他们的社区内，他们将获得综合的 PrEP/ART、MOUD、减少伤害服务 释放后 6 个月干预期间的 MHU。有 2 个具体目标： 目标 1（干预 有效性）：比较使用 PN 与 MHU 服务交付对参与者时长的有效性 释放后 6 个月内服用初始 PrEP（预防）/ART（治疗）药物的时间 释放。次要结果将检查 PrEP 和 HIV 护理结果的连续性， 包括（但不限于）以下额外措施：针对 PLH 的 HIV 病毒抑制、PrEP 依从性、艾滋病毒危险行为； HCV 措施，例如 HCV 检测和与治疗的联系；性方面的 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 相关措施：OUD/SUD 诊断、 MOUD 处方接收和保留、阿片类药物和兴奋剂的使用以及过量事件。目标 2（实施）： 评估 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（出院人员医疗保健利用的影响、机构间工作组的贡献 成员的成果）；可接受性（参与者满意度、感知有用性）；维持（续 利用率），以及实施和维持这些方法以及扩大额外规模所需的成本 社区。还将评估整个社区提供商范围内的服务获取障碍。