Advancing health equity through integration of community social and HIV services

项目摘要/摘要 拟议的CFAR/ARC终止艾滋病毒流行(EHE)补编将涉及“预防”支柱。社交 健康的结构性决定因素被认为是易受艾滋病毒感染和参与 艾滋病毒预防和助长了美国边缘化社区在艾滋病毒方面的不平等。 然而，艾滋病毒服务往往与社会服务割裂开来，限制了有社会服务的人的潜力。 还需要接受艾滋病毒预防服务，反之亦然，导致错过改善的机会 艾滋病毒预防和护理连续体的成果以及艾滋病毒高危人群的普遍福祉。入门 Hermanos、Gay City和POCAAN是服务于不同人群的3个基于社区的组织(CBO 华盛顿州金县受艾滋病毒影响。它们植根于艾滋病毒预防，并提供艾滋病毒/性传播感染检测、PrEP服务、 和案件管理，并越来越多地提供社会服务，从药物滥用服务， 移民法律服务，监禁后服务，到医疗保险导航，有不同程度的 服务融合。这项建议建立在现有的学术和社区伙伴关系和成功的EHE的基础上 规划项目，通过该项目，我们在目标、驱动因素和潜在方法方面建立了共识 用于增强每个CBO的服务集成。在这里，我们建议将实践促进(PF)作为一种 加强艾滋病毒-社会服务一体化，从而解决艾滋病毒的社会决定因素并减少 与艾滋病毒有关的不平等现象。实践便利化是一种基于证据的实施和能力建设方法 用于初级保健的持续质量改进(QI)。在这里，它将导致测试和研究社区- 推动和拥有实践变革，以CBO产生的想法为基础，增强服务集成 计划项目期间的工作人员。我们的评估将以RE-AIM(REACH、有效性、采用率、 实施、维护)框架，并辅之以普罗科特成果框架的构造。 首先，我们将分析规划数据，以评估PF对筛查、转诊和采用 艾滋病毒服务对象中的社会服务和社会服务对象中的艾滋病毒服务 根据每个组织确定的关键人口统计数据，这些结果之间存在差异。第二，我们将使用流程 数据、员工调查和与员工的焦点小组讨论，以进行混合方法评估 PF的可接受性、可行性、适当性、采用实施和潜在维护。第三，我们 将通过与工作人员进行重点小组讨论，确定转介和接受社会服务的决定因素。 这些目标加在一起，将导致加强、综合提供艾滋病毒和社会服务，并提高能力。 在三个CBO进行QI，并确定其他环境下的服务集成模式。归根结底， 社会服务与以社区为基础的艾滋病毒服务的有效结合有可能增加参与度 在艾滋病毒预防方面，促进卫生公平，改善患者的总体健康和福祉。

PROJECT SUMMARY/ABSTRACT The proposed CFAR/ARC Ending the HIV Epidemic (EHE) supplement will address the “Prevent” Pillar. Social and structural determinants of health are recognized as critical factors in vulnerability to HIV and engagement in HIV prevention and contribute to inequities in HIV experienced by marginalized communities in the U.S. However, HIV services are often siloed from social services, limiting the potential for people with social service needs to also receive HIV prevention services and vice versa, resulting in missed opportunities to improve outcomes along the HIV prevention and care continuum and general well-being of people at risk for HIV. Entre Hermanos, Gay City, and POCAAN are 3 community-based organizations (CBOs) serving diverse populations affected by HIV in King County, WA. They are rooted in HIV prevention and offer HIV/STI testing, PrEP services, and case management and increasingly provide social services, ranging from substance abuse services, immigration legal services, post-incarceration services, to health insurance navigation, with varying levels of service integration. This proposal builds on an existing academic-community partnership and a successful EHE planning project through which we have built consensus around objectives, drivers, and potential approaches for enhancing service integration at each CBO. Here, we propose to evaluate practice facilitation (PF) as an approach to enhance HIV-social service integration and thereby address social determinants of HIV and reduce HIV-related inequities. Practice facilitation is an evidence-based approach for implementing and building capacity for continuous quality improvement (QI) in primary care. Here, it will lead to testing and studying community- driven and -owned practice changes for enhancing service integration, building from ideas generated by CBO staff during the planning project. Our evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework and supplemented by constructs from Proctor’s Outcome Framework. First, we will analyze programmatic data to evaluate the impact of PF on screening, referrals, and uptake of social services among HIV service clients and for HIV services among social service clients as well as on disparities in these outcomes by key demographics identified by each organization. Second, we will use process data, staff surveys, and focus group discussions with staff to conduct a mixed methods assessment of acceptability, feasibility, appropriateness, adoption implementation, and potential maintenance of PF. Third, we will identify determinants of referral and uptake of social services through focus group discussions with staff. Together, these aims will lead to strengthened, integrated HIV and social service delivery and increased capacity to conduct QI at the three CBOs and identify models for service integration in other settings. Ultimately, the effective integration of social services with community-based HIV services has potential to increase engagement in HIV prevention, advance health equity, and improve client general health and well-being.