Addressing health and social care needs of older people with HIV suffering from mental health disorders in Georgia

当前Georgian研究（NIH/FIC授权3D 43 TW 011532 - 03 S1，血管）生成的证据 艾滋病毒感染者中认知障碍和痴呆症（VCID）的贡献 格鲁吉亚），表明抑郁症（50%），焦虑症（45%），以及物质使用的高患病率 在格鲁吉亚40岁以上的OPWH人群中，存在精神障碍（SUD; 26%）和酒精使用障碍（AUD; 21%）。 然而，如何提供适当的以人为本的健康和社会护理仍然是一个重大挑战 在格鲁吉亚，有一个后苏联的卫生系统，在筒仓内组织服务。 目前，OPWH以高度集中和垂直的模式接受艾滋病毒/艾滋病护理，但缺乏整合。 精神健康和几乎不存在的社会护理服务。另一方面，心理健康服务是 主要通过专门的精神病诊所和精神病院提供。目前尚不清楚这些现有的 可以弥合服务孤岛，以满足OPWH的心理健康需求， 以及艾滋病毒护理，并需要在社区，而不是在机构内的这种服务。因为格鲁吉亚缺少 以社区为基础的保健和社会护理服务以及对OPWH的干预措施;新的个人和社区 如果OPWH要实现以下目标，就需要在社区和卫生系统层面制定以中心为中心的方法 全面照顾他们的需要。 本申请是对Fogarty HIV研究培训补助金（D43 TW 011532;战略培训）的补充 格鲁吉亚消除艾滋病伙伴关系）。我们建议解决大脑健康结果对 格鲁吉亚公共卫生办公室艾滋病毒护理的连续性。格鲁吉亚公共卫生硕士研究生培训将通过以下方式运作： 1.艾滋病毒老龄化高级教学培训（重点是心理健康障碍，以及相关的健康和社会问题） 护理需求）和混合方法研究（侧重于健康和社会护理服务），以及健康和社会 护理服务调查方法;目标2。卫生和社会保健服务调查和数据的实践培训 目标2.a.通过以下方式编制保健和社会保健服务清单： 在相关公共和私营医疗机构开展精神卫生和社会护理服务调查， 以及各自的服务提供者社区组织/非政府组织;目标2b.探索健康和社会保健服务需求， 服务障碍（例如，在个人层面、社会或人际层面以及结构性层面上的护理障碍 包括与艾滋病毒有关的耻辱以及影响获得保健服务的其他社会决定因素 服务），以及对健康和社会护理服务的态度和期望（例如，电流可接受性 服务，包括设置、位置、内容等）通过对28名妇女进行定性研究， OPWH（每组有（1）抑郁，（2）焦虑，（3）SUD，（4）AUD的OPWH进行7次深入访谈）。 我们的研究结果将为制定干预措施以减少心理健康障碍的负面影响提供信息 在这一目标群体中，并改善艾滋病毒护理的长期连续性。这个项目的成功完成 将促进新的研究，重点是设计和测试相关的，创新的干预措施， 更严格的研究设计（例如，RCT）。这些未来的可交付成果将通过艾滋病毒-老龄化-心理 一名格鲁吉亚受训人员、博士生，曾在艾滋病毒方面有过经验， 研究，谁将接受先进的教学和实践培训，在发展战略技能。

The evidence generated from the current Georgian study (NIH/FIC grant 3D43TW011532-03S1, Vascular contributions to cognitive impairments and dementia (VCID) among people living with HIV in the country of Georgia), demonstrates a high prevalence of depression (50%), anxiety (45%), as well as substance use disorders (SUD; 26%) and alcohol use disorders (AUD; 21%) among OPWH who are >40 years in Georgia. However, significant challenge remains how to provide appropriate person-centered health and social care services to such OPWH in Georgia, which has a post-Soviet health system with services organized within silos. Currently, OPWH receive HIV/AIDS care in a highly centralized and vertical model, but with poorly integrated mental health and virtually non-existent social care services. On the other hand, mental health services are mainly delivered through specialized psychiatric clinics and mental hospitals. It is unclear how these existing service silos can be bridged in order to serve the mental health needs of OPWH who need both mental health as well as HIV care, and need such services in the community, not within institutions. Because Georgia lacks community-based health and social care services and interventions for OPWH; novel person- and community- centered approaches, at both community and health system levels, will need to be developed if OPWH are to receive comprehensive care for their needs. This application is a supplement to Fogarty HIV Research Training Grant (D43TW011532; Strategic Training Partnership to End AIDS in Georgia). We propose to address the negative impact of brain health outcomes on HIV care continuum among OPWH in Georgia. Georgian MPH graduate training will be operationalized via: Aim 1. Advanced didactic training in HIV-aging (focus on mental health disorders, and the related health and social care needs) and mixed methods research (focus on health and social care services), as well as health and social care services survey methods; and Aim 2. Hands-on training in health and social care services survey and data analysis, the goals of which are to: Aim 2.a. Develop an inventory of health and social care services via conducting mental health and social care services survey in relevant public and private healthcare facilities, as well as the respective service provider CBOs/NGOs; Aim 2b. Explore health and social care service needs, barriers to services (e.g., barriers to care at the individual level, the social or interpersonal level, and structural level, including HIV-associated stigma, as well as other social determinants of health affecting access to services), and attitudes and expectations for health and social care services (e.g., acceptability of current services, including setting, location, content, etc.) among OPWH via conducting qualitative research among 28 OPWH (seven in-depth interviews per group of OPWH with (1) depression, (2) anxiety, (3) SUD, (4) AUD). Our results will inform development of interventions to reduce the negative impact of mental health disorders among this target group and improve HIV care continuum in the long term. This project's successful completion will catalyze new research that can focus on designing and testing relevant, innovative interventions using a more rigorous study design (e.g., RCT). These future deliverables will be achieved through HIV-aging-mental health research capacity building of one Georgian trainee, doctoral student with previous experience in HIV research, who will receive advanced didactic and hands-on training in the development of a strategic skillset.