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

实现患者结果报告的公平性，以便及时评估艾滋病毒感染者和药物使用的生活（ePORTAL HIV-S）

• 批准号: 10740440
• 负责人: Neda Laiteerapong
• 金额: $ 76.79万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10740440
• 关键词: AIDS prevention; Address; Affect; Black American; Black Populations; Black race; Caring; Case Manager; Cellular Phone; Chicago; Clinic; Clinic Visits; Communities; Community Health Aides; Depression screen; Diagnosis; Disparity; Education; Effectiveness; Electronics; Enrollment; Ensure; Epidemic; Equity; Face; Funding; Gender; Goals; HIV; HIV diagnosis; Health; Health Technology; Home; Housing; Incidence; Income; Insurance; Intervention; Interview; Learning; Life; Managed Care; Mediating; Medicine; Minority Groups; Modeling; Neighborhoods; Newly Diagnosed; Outcome; Patient Outcomes Assessments; Patients; Persons; Prevalence; Privacy; Provider; Psychiatrist; Psychiatry; Public Health; Race; Randomized, Controlled Trials; Secure; Sexual and Gender Minorities; Side; Site; Social Work; Structural Racism; Substance Use Disorder; Telephone; Text Messaging; Time; Training; Universities; Viral; Visit; Work; barrier to care; behavioral health; care systems; collaborative care; density; design; digital health; effectiveness evaluation; health care availability; health equity; improved; interest; mortality; patient engagement; patient portal; patient-clinician communication; population health; prevention service; programs; response; routine screening; screening; social health determinants; social stigma; substance use; syndemic; treatment center; user centered design; web site

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.

项目摘要 物质使用障碍（SUD）和艾滋病毒是协同流行病（syndemics）， 美国黑人结构性种族主义与获得医疗保健的机会不足、污名化和刑事定罪有关， 特别是在那些与性别和性少数群体有关的交叉身份的人中， 艾滋病毒和可持续发展成果之间的差距。 在艾滋病毒携带者中，SUD往往得不到承认和治疗。只有大约一半的艾滋病毒护理站点定期进行筛查， 关于SUD治疗在初步工作中，我们发现，在艾滋病诊所接受评估的患者中， 候诊室符合SUD标准，但65%未被诊断为SUD。一个有希望的战略， 解决对PLWH进行SUD筛查的结构性障碍是使用电子患者门户网站。入口安全 这些网站使患者能够获得健康信息，并允许与提供者进行安全的信息传递。他们 与改善健康结果和患者参与度相关。重要的是，虽然大多数SUD 筛查目前发生在诊所访视期间，可利用门户网站进行SUD筛查，以接触 错过诊所就诊，这在艾滋病毒感染者和SUD患者中更为常见。我们的前期工作 证明了门户网站在人口健康方法中用于行为健康筛查的潜力， 但少数民族不太可能在门户网站注册。需要采取各种办法， 黑色PLWH用于SUD筛查的门户网站。 除了SUD筛查，黑人PLWH面临SUD治疗的结构性障碍，包括缺乏治疗 在黑人居民比例较高的社区设立中心。然而，一种新的治疗模式 （协作护理模式（CoCM））将社会工作护理经理和咨询精神病学家整合到 主要设置，并已显示改善SUD的结果。SUD的CoCM可以解决治疗障碍 与对黑人艾滋病毒携带者和南部非洲发展共同体的污名化和结构性种族主义有关。 该提案将实施和评估多层次干预措施，以减少SUD筛查的障碍 （基于诊所，面对面）和治疗（以患者为中心），我们称之为ePORTAL HIV-S的计划。ePORTAL HIV- S将在芝加哥公共卫生部资助的南区健康之家（S2 H2）实施， 该公司是芝加哥南部黑人社区艾滋病预防和护理服务的主要提供者 艾滋病毒和SUD的严重影响。除了我们的社区咨询委员会外，我们建议 4个目标：1）设计和实施一项战略，以增加黑人PLWH患者的门户网站参与; 2） 进行随机对照试验，以评估人群健康与常规（临床访视）SUD的有效性 在艾滋病诊所对艾滋病病毒感染者进行筛查; 3）在艾滋病诊所实施和评估针对SUD的CoCM;以及4） 为外部传播ePORTAL HIV-S制定实施指南。我们的最终目标是 在黑人艾滋病毒携带者中实现SUD筛查和治疗的健康公平。