Advancing health equity through integration of community social and HIV services

项目概要/摘要 拟议的CFAR/ARC终止艾滋病毒流行补充将涉及“预防”支柱。社会 健康的结构性决定因素被认为是易感染艾滋病毒和参与 艾滋病毒预防，并有助于艾滋病毒的不平等经历了边缘化社区在美国。 然而，艾滋病毒服务往往孤立于社会服务之外，限制了人们获得社会服务的潜力 需要同时接受艾滋病毒预防服务，反之亦然，导致错失改善的机会。 艾滋病毒预防和护理连续体的沿着成果以及艾滋病毒高危人群的总体福祉。Entre Hermanos、Gay City和POCAAN是3个服务于不同人群的社区组织（CBO）。 在华盛顿州金县感染艾滋病毒。它们植根于艾滋病毒预防，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， 移民法律的服务，监禁后的服务，健康保险导航，不同程度的 服务整合该提案建立在现有的学术-社区伙伴关系和成功的EHE基础上 规划项目，通过该项目，我们已就目标、驱动因素和潜在方法达成共识 以加强每个CBO的服务整合。在这里，我们建议评估实践促进（PF）作为一个 采取办法，加强艾滋病毒与社会服务的结合，从而解决艾滋病毒的社会决定因素， 与艾滋病毒有关的不平等。实践促进是一种基于证据的实施和能力建设方法 持续质量改进（QI）在初级保健。在这里，它将导致测试和研究社区- 基于CBO产生的想法，推动并拥有增强服务集成的实践变化 在规划项目期间。我们的评估将遵循RE-AIM（覆盖范围、有效性、采用率， 实施、维护）框架，并由普罗克特成果框架的结构加以补充。 首先，我们将分析项目数据，以评估PF对筛查、转诊和吸收的影响。 在艾滋病毒服务客户中提供艾滋病毒服务， 各组织确定的主要人口统计数据显示，这些结果存在差异。其次，我们将使用过程 数据、工作人员调查和与工作人员的焦点小组讨论， 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 将通过与工作人员的焦点小组讨论，确定转介和接受社会服务的决定因素。 这些目标合在一起，将导致加强和综合提供艾滋病毒和社会服务，并提高能力 在三个社区组织开展质量检查，并确定在其他环境中进行服务整合的模式。最终 社会服务与社区艾滋病毒服务的有效结合有可能增加参与 在艾滋病毒预防方面，促进保健公平，并改善服务对象一般健康和福利。

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.