Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE).

治疗依从性、咨询和研究综合导航服务 (INSTACARE)。

• 批准号: 10266233
• 负责人: SONJIA KENYA
• 金额: $ 25万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-24 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10266233
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; African American; Ambulatory Care; Area; CD4 Lymphocyte Count; CD4 Positive T Lymphocytes; COVID-19; Caring; Cause of Death; Cessation of life; Clinic; Communication; Communities; Community Health Aides; Continuity of Patient Care; Counseling; County; Disease Progression; Education; Effectiveness; Epidemic; Experimental Designs; Florida; Focus Groups; Funding; Goals; Government; HIV; HIV Infections; Health Personnel; Health system; Healthcare Systems; Home environment; Hospitalization; Hospitals; Human immunodeficiency virus test; Improve Access; Incidence; Intervention; Interview; Investigation; Knowledge; Mental Health; Minority; Neighborhoods; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Play; Population; Prevention; Provider; Public Hospitals; Randomized; Recording of previous events; Research; Role; Sampling Studies; Self Efficacy; Services; System; Testing; United States National Institutes of Health; Universities; Viral; Viral Load result; Visit; Work; base; clinical care; community involvement; design; effective therapy; follow-up; group intervention; health care delivery; health care service utilization; high risk; implementation research; improved; improved outcome; infection rate; informant; intervention effect; medication compliance; minority health; mobile computing; mortality; multi-component intervention; outreach; prevent; primary outcome; programs; recruit; response; safety net; screening; secondary outcome; telehealth; treatment adherence; treatment as usual; treatment services; virtual technology

PROJECT SUMMARY The goal of this research is to determine whether a CHW intervention including a mobile telehealth (M-Health) component can help achieve long term viral suppression among Black people with poorly controlled HIV. The US Government’s Ending the HIV Epidemic (EHE) initiative identified Miami-Dade County as a major epicenter of HIV. The County suffers from the Nation’s highest HIV incidence and excess AIDS-related mortality. Despite the availability of effective treatment and prevention, HIV disparities persist among certain demographic groups, especially Black communities. While Blacks comprise just 17% of the County’s population, they account for 64% of all AIDS-related deaths. This highlights a critical need for locally-designed strategies to facilitate improved access to HIV treatment and support for medication adherence. For over thirty years the University of Miami’s Center for AIDS Research (CFAR) has been dedicated to advancing HIV/AIDS research and partnering with the community to prevent, treat, and cure HIV/AIDS. This includes 12 years of research and service initiatives involving community health worker (CHW) interventions addressing disparities among Black people living with HIV (PLH). Our pilot work has already shown that Black PLH randomized to receive CHW support for 12 months had significantly improved viral suppression compared to those who received the usual standard of HIV care. More recently, our team has developed enhanced CHW interventions that combine personalized, home-based CHW support with mobile telehealth strategies to improve minority health outcomes. Building upon this research, we propose the Integrated Navigation Services for Treatment Adherence, Counseling, and Research (INSTACARE) study, a comprehensive CHW intervention to improve treatment adherence and viral suppression among Black PLH. Leveraging our established CHW network, the proposed research will integrate CHWs into HIV clinical care teams and examine the effects of a multi-level CHW and telehealth approach on viral suppression among Black people with uncontrolled HIV (viral load > 200 copies/ml). This proposal also builds upon our prior studies as well as our ongoing CHW programs providing street-based HIV outreach, education, and rapid screening in Black communities plagued by the worst HIV outcomes. Three hundred Black PLH who have not achieved viral suppression will be recruited from Miami’s public healthcare system. Participants will be randomized to a 12- month CHW intervention enhanced with mobile telehealth support versus usual HIV care. Pre and post assessments will determine intervention effects on viral load, medication adherence, hospitalizations, and self- efficacy in adhering to treatment and taking medications. The project will provide critically important research findings addressing existing knowledge gaps on the effectiveness of CHWs at improving HIV outcomes among Black PLH.

项目摘要 本研究的目的是确定包括移动的远程医疗（M-Health）在内的CHW干预是否 这种成分可以帮助艾滋病毒控制不佳的黑人实现长期的病毒抑制。 美国政府的终止艾滋病毒流行（EHE）倡议将迈阿密-戴德县确定为主要的 艾滋病的中心该县的艾滋病发病率和艾滋病相关死亡率是全国最高的。 尽管可以获得有效的治疗和预防，但艾滋病毒在某些人口中的差异仍然存在。 尤其是黑人社区。虽然黑人只占该县人口的17%，但他们占 占所有艾滋病相关死亡的64%。这突出表明，迫切需要制定当地战略， 改善获得艾滋病毒治疗的机会，并支持坚持服药。 三十多年来，迈阿密大学艾滋病研究中心（CFAR）一直致力于 推进艾滋病毒/艾滋病研究，与社区合作预防、治疗和治愈艾滋病毒/艾滋病。这 包括12年的研究和服务计划，涉及社区卫生工作者（CHW）的干预措施 解决黑人艾滋病毒感染者之间的差距。我们的试点工作已经表明， PLH随机接受CHW支持12个月，与对照组相比， 给那些接受常规艾滋病护理的人。最近，我们的团队开发了增强型CHW 将联合收割机个性化的家庭保健支持与移动的远程保健战略相结合的干预措施， 少数民族的健康状况。在此基础上，我们提出了集成导航服务， 治疗依从性、咨询和研究（CANACARE）研究，一项综合性CHW干预， 改善黑人PLH患者治疗依从性和病毒抑制。 利用我们已建立的社区卫生工作网络，拟议的研究将把社区卫生工作纳入艾滋病毒临床护理 团队，并检查多层次的CHW和远程医疗方法对黑人中病毒抑制的影响 未受控制的HIV感染者（病毒载量> 200拷贝/ml）。这一建议也建立在我们以前的研究基础上， 以及我们正在进行的CHW计划，提供街头艾滋病毒外展，教育和快速筛查， 黑人社区受到最严重的艾滋病毒后果的困扰。300名黑人PLH谁没有实现病毒 将从迈阿密的公共医疗系统中招募抑制剂。参与者将被随机分配到12- 与常规艾滋病毒护理相比，通过移动的远程保健支持加强了一个月的社区卫生保健干预。前后 评估将确定干预对病毒载量、药物依从性、住院和自我治疗的影响。 坚持治疗和服用药物的疗效。该项目将提供至关重要的研究 调查结果，解决了社区卫生工作者在改善艾滋病毒成果方面的现有知识差距， 黑色PLH。