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

问题：迫切需要联系参与刑事司法的妇女(WICJ)，以便 拯救生命的循证PrEP和OUD(Moud)药物，使用创新 医疗保健提供模式跨越了现有的社会和结构性参与障碍。 目的：我们使用最新验证的决策辅助工具和eHealth远程提供集成 为康涅狄格州纽黑文(CT)的OUD社区WICJ做准备和Moud 阿拉巴马州伯明翰(AL)。方法：我们将招募250名符合PrEP条件的WICJ，OUD至 进行随机化以：a)“雅典娜”战略，其中包括决策辅助+电子健康 对于使用决策辅助的输出与提供商进行远程集成的PrEP/Moud；或b) 决策辅助-仅可转介至基于社区的PrEP/Moud。随机化将是分层的 按地点分类；过去6个月使用任何兴奋剂；以及Moud的基线接受情况。随访研究 评估在1个月、3个月和6个月进行。为了了解实施情况，我们将 人口建模，并通过焦点小组使用Nomal 小组技术和深入的个人访谈。目标：该项目的目标是：1) 将雅典娜策略与决策辅助进行比较-仅就患者层面的参与度而言 考虑关键地点差异的准备和OUD护理连续性；以及2)评估纵向扩展 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 与电子健康互动，在WICJ的两个不同的流行病学和 实施环境(CT和AL)，使用标准化的实施定义 结果。意义：拟议的研究直接涉及RFA的主要目标- 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 减少耻辱并改善关键优先人群的PrEP和OUD护理连续性 WICJ与OUD。重要性很高，因为WICJ的重点是艾滋病高危人群 在这些人中，PrEP的交付策略是有限的。创新是通过使用污名来实现的- 减少决策辅助和电子健康，以克服PrEP采用的记录障碍，以及 在两个不同的环境中衡量临床和实施结果的设计。 可行性很高，因为可以访问大量WICJ，在两个环境中都有OUD，并且 具有丰富的内容专业知识、协作和支持性研究的研究团队 基础设施。公共卫生意义重大，因为向关键人群提供PrEP是 是EHE的核心，并评估实施因素，以指导在两种不同环境中的纵向扩展 将有助于指导需要预防艾滋病毒的其他环境。

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.