Integrated eHealth for HIV and Substance Use Disorders in Justice-involved Women

针对参与司法的妇女的艾滋病毒和药物滥用障碍的综合电子保健

• 批准号: 10573552
• 负责人: Jaimie Meyer
• 金额: $ 74.2万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10573552
• 关键词: AIDS prevention; Address; Alabama; Behavioral; COVID-19; Caring; Clinical; Collaborations; Communities; Connecticut; Continuity of Patient Care; Criminal Justice; Decision Aid; Diagnosis; Diversion Program; Effectiveness; Elements; Enrollment; Epidemic; Epidemiology; Focus Groups; Follow-Up Studies; Geography; HIV; HIV Infections; HIV risk; Health; Hepatitis C Therapy; Hepatitis C virus; Individual; Intervention; Interview; Jail; Justice; Life; Measures; Methods; Modeling; NIH Office of AIDS Research; Opioid; Outcome; Output; Patients; Pharmaceutical Preparations; Population; Prisons; Provider; Public Health; Publishing; Quality-Adjusted Life Years; Randomized; Research; Research Infrastructure; Resources; Risk; Sampling; Savings; Service delivery model; Sexually Transmitted Diseases; Site; Standardization; Stigmatization; Stimulant; Structure; Substance Use Disorder; Supervision; Surveys; System; Techniques; Testing; Time; Woman; Work; base; clinical implementation; comorbidity; court; design; evidence base; health care delivery; health disparity; implementation barriers; implementation context; implementation determinants; implementation evaluation; implementation outcomes; implementation science; improved; innovation; member; opioid use disorder; parole; pre-exposure prophylaxis; preference; probation; recruit; remote delivery; scale up; secondary outcome; social stigma; social structure; stimulant use; support tools; telehealth; tool; treatment arm; treatment as usual; unethical; uptake

Problem: There is urgent need to reach women involved in criminal justice (WICJ) for lifesaving, evidence-based PrEP and medications for OUD (MOUD), using innovative healthcare delivery models that surmount existing social and structural barriers to engagement. Purpose: We use our newly validated decision aid and eHealth to remotely deliver integrated PrEP and MOUD to community-based WICJ with OUD in New Haven, Connecticut (CT) and Birmingham, Alabama (AL). Methods: We will enroll 250 PrEP-eligible WICJ with OUD to undergo randomization to: a) the “Athena” strategy, which includes the decision aid + eHealth for remote integrated PrEP/MOUD with a provider using outputs from the decision aid; or b) decision aid-only with referral to community-based PrEP/MOUD. Randomization will be stratified by site; past 6-month use of any stimulants; and baseline receipt of MOUD. Follow-up study assessments occur at months 1, 3, and 6. To understand implementation, we will conduct population modeling and engage with relevant stakeholders through focus groups using nominal group technique and in-depth individual interviews. Aims: The Aims of the project are: 1) To compare the Athena strategy to decision aid-only in terms of patient-level engagement in the PrEP and OUD care continua, considering key site differences; and 2) To assess scale-up potential of the Athena strategy in terms of modelled long-term outcomes and how stakeholders interact with eHealth for integrated PrEP/MOUD in WICJ in two diverse epidemiological and implementation contexts (CT and AL), using standardized definitions of implementation outcomes. Significance: The proposed research directly addresses the key objectives of RFA- DA-22-040 and priorities of the NIH Office of AIDS Research by testing innovative interventions to reduce stigma and improve the PrEP and OUD care continua in the key priority population of WICJ with OUD. Importance is high due to the focus on WICJ with OUD who have high HIV risk and in whom PrEP delivery strategies are limited. Innovation is high through use of a stigma- reducing decision aid and eHealth to overcome documented barriers to PrEP uptake, and a design that measures clinical alongside implementation outcomes in two diverse settings. Feasibility is high due to access to large numbers of WICJ with OUD in both contexts and a research team with considerable content expertise, collaborations, and supportive research infrastructure. Public health significance is high because delivering PrEP to key populations is central to EHE and assessing implementation factors to guide scale-up in two diverse contexts will help guide other settings where HIV prevention is needed.

问题：迫切需要接触参与刑事司法的妇女， 救生，循证PrEP和药物OUD（MOUD），使用创新的 医疗保健提供模式，克服现有的社会和结构性障碍的参与。 目的：我们使用新验证的决策辅助和电子健康远程提供集成的 PrEP和MOUD以社区为基础的WICJ与OUD在纽黑文，康涅狄格州（CT）， 伯明翰，亚拉巴马（AL）。方法：我们将招募250名符合PrEP条件的OUD WICJ， 随机分配至：a）“雅典娜”策略，包括决策辅助+电子健康 对于使用决策辅助输出的提供者的远程集成PrEP/MOUD;或B） 仅提供决策援助，并转介到基于社区的PrEP/MOUD。对随机化进行分层 按研究中心列出;过去6个月使用任何兴奋剂;基线接受MOUD。随访研究 在第1、3和6个月进行评估。为了了解实施情况，我们将进行 人口建模，并通过使用名义上的焦点小组与相关利益相关者接触 小组技术和深入的个人访谈。目标：该项目的目标是：1） 在患者参与方面，比较Athena策略与仅决策辅助 PrEP和OUD护理持续，考虑关键站点差异;以及2）评估规模扩大 雅典娜战略在模拟长期成果方面的潜力以及利益攸关方如何 在两种不同的流行病学和 实施环境（CT和AL），使用实施的标准化定义 结果。意义：拟议的研究直接解决RFA的关键目标- DA-22-040和NIH艾滋病研究办公室通过测试创新干预措施的优先事项 减少耻辱感，改善PrEP和OUD护理的持续性， WICJ与OUD。重要性很高，因为重点是艾滋病毒高风险的OUD WICJ 并且PrEP提供策略有限。创新是高通过使用一个耻辱- 减少决策援助和电子健康，以克服记录在案的PrEP吸收障碍，以及 该设计在两种不同的环境中测量临床和实施结果。 可行性很高，因为在这两种情况下都可以获得大量具有OUD的WICJ， 研究团队具有相当的内容专业知识，合作和支持性研究 基础设施演进公共卫生意义很高，因为向重点人群提供PrEP是 EHE的核心，评估实施因素，以指导在两种不同情况下的规模扩大 将有助于指导其他需要预防艾滋病毒的环境。