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.

项目总结 这项研究的目标是确定CHW干预是否包括移动远程健康(M-Health) 该成分有助于在艾滋病毒控制不佳的黑人中实现长期病毒抑制。 美国政府终止艾滋病毒流行(EHE)倡议将迈阿密-戴德县确定为主要 艾滋病病毒的震中。该县是全国艾滋病毒发病率最高的县，艾滋病相关死亡率居高不下。 尽管有有效的治疗和预防措施，但艾滋病毒在某些人群中的差距依然存在。 团体，尤其是黑人社区。虽然黑人只占该县人口的17%，但他们占了 占所有艾滋病相关死亡人数的%。这突出表明，迫切需要当地设计的战略来促进 更好地获得艾滋病毒治疗和支持坚持用药。 迈阿密大学艾滋病研究中心(CFAR)三十多年来一直致力于 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年的研究和服务倡议，涉及社区卫生工作者(CHW)干预 解决艾滋病毒携带者(PLH)黑人之间的差异。我们的试点工作已经表明，布莱克 与随机接受CHW支持12个月的PLH相比，显著改善了病毒抑制 给那些接受了通常标准的艾滋病毒护理的人。最近，我们的团队开发了增强的CHW 将个性化、基于家庭的CHW支持与移动远程医疗策略相结合的干预措施，以改善 少数群体的健康结果。在此研究的基础上，我们提出了综合导航服务 治疗依从性、咨询和研究(INSTACARE)研究，CHW对 改善Black PLH患者的治疗依从性和病毒抑制。 利用我们已建立的CHW网络，拟议的研究将把CHW整合到HIV临床护理中 团队，并检查多水平CHW和远程医疗方法对黑人中病毒抑制的影响 艾滋病毒携带者(病毒载量200拷贝/毫升)。这项建议还建立在我们之前的研究基础上，如 以及我们正在进行的CHW计划，提供街头艾滋病毒宣传、教育和快速筛查 黑人社区受到最糟糕的艾滋病毒结果的困扰。300名尚未实现病毒传播的黑人PLH 镇压将从迈阿密的公共医疗系统中招募。参与者将被随机分成12- 与通常的艾滋病毒护理相比，每月CHW干预通过移动远程保健支持得到加强。前置和后置 评估将确定对病毒载量、用药依从性、住院和自我保护的干预效果 坚持治疗和服药的效果。该项目将提供至关重要的研究。 关于社区卫生工作者在改善艾滋病毒结果方面存在的现有知识差距的调查结果 黑色的PLH。