Achieving Equity in Patient Outcome Reporting for Timely Assessments of Life with HIV and Substance Use (ePORTAL HIV-S)

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PROJECT SUMMARY Substance use disorder (SUD) and HIV are synergistic epidemics (syndemics) disproportionately affecting Black Americans. Structural racism related to inadequate access to healthcare, stigma, and criminalization, especially among those with intersectional identities related to gender and sexual minorities, further exacerbate disparities in HIV and SUD outcomes. SUD is often unrecognized and untreated among PLWH. Only about half of HIV care sites routinely screen and refer to SUD treatment. In preliminary work, we found that nearly half of patients assessed in an HIV clinic waiting room met criteria for a SUD, but 65% had not been diagnosed with SUD. A promising strategy to address structural barriers to SUD screening for PLWH is use of electronic patient portals. Portals are secure websites that give patients access to health information and allow for secure messaging with providers. They are associated with improved health outcomes and patient engagement. Importantly, while most SUD screening currently occurs during clinic visits, portals can be utilized for SUD screening to reach patients who miss clinic visits, which is more common among people with HIV and SUD. Our preliminary work has demonstrated the potential of the portal for use in a population health approach to behavioral health screening, but minoritized populations are less likely to enroll in portals. Approaches are need to enhance engagement of Black PLWH for utilization of the portal for SUD screening. Beyond SUD screening, Black PLWH face structural barriers to SUD treatment, including the lack of treatment centers in communities with higher proportions of Black residents. However, a new model of treatment (Collaborative Care Model (CoCM)) integrates a social work care manager and consulting psychiatrist into the primary setting and has been shown improve SUD outcomes. CoCM for SUD could address treatment barriers related to stigma and structural racism for Black PLWH and SUD. This proposal will implement and evaluate multi-level interventions to decrease barriers to SUD screening (clinic-based, in-person) and treatment (referral-focused), a program we call ePORTAL HIV-S. ePORTAL HIV- S will be implemented at the Chicago Department of Public Health-funded South Side Health Home (S2H2), the main provider of HIV prevention and care services for Chicago’s South Side, a majority Black community disproportionately impacted by HIV and SUD. Alongside our Community Advisory Board, we propose to carry out 4 aims: 1) Design and implement a strategy to increase patient portal engagement among Black PLWH; 2) Perform a randomized controlled trial to assess effectiveness of population health vs. usual (clinic-visit) SUD screening among PLWH in an HIV clinic; 3) Implement and evaluate CoCM for SUD in an HIV clinic; and 4) Develop an implementation guide for external dissemination of ePORTAL HIV-S. Our ultimate goal is to achieve health equity in SUD screening and treatment among Black PLWH.