Mobile Application to Improve Care Coordination among HIV Clinic and Substance Use Treatment Providers

项目摘要/摘要 吸毒与艾滋病毒护理的联系不佳、护理保留率降低、性风险增加 行为，减少对药物的依从性，导致较差的临床结果，并增加艾滋病毒 变速箱。使用药物的艾滋病毒感染者(HPWUD)精神疾病和精神疾病的共生率较高 医疗诊断，从而提高了服务的利用率。许多结构性和体制性障碍阻碍了 将艾滋病毒治疗和药物使用(SU)结合起来。将移动应用程序与 循证培训模式为改善护理协调和联系提供了一种创新方法 需要护理的患者需要双重治疗。通过平板设备交付的mHealth应用程序提供了独特的 联系位于非现场诊所的艾滋病毒和SU治疗提供者的渠道。这项研究将是第一阶段的试点和 第一个使用基于理论的护理协调模型来开发护理的可行性研究 为HPWUD提供服务的治疗提供者的协调干预(CCI)。拟议的研究旨在开发 一个安全的移动技术平台，它将：(A)实现多个供应商之间的快速通信 (B)加强与双重护理的联系，(C)改善患者服务的协调。CCI还将 利用循证培训模式增加提供者在相关艾滋病毒、PrEP和SU问题上的知识。 所提出的为患者整合双重护理的方法有望是一种有效和容易的方法 整合艾滋病毒/SU护理的可传播平台，将促进提供者之间的沟通， 多个诊所，并允许有效管理患者的治疗、转诊和服务利用。这 项目将使用混合方法检查可接受性、可行性和可持续性潜力。分三个阶段， 采用自上而下的研究方法，对干预措施进行适应、提炼和中试。第一阶段将 包括与关键利益相关者的个人面谈，以及对内部推荐和沟通流程的审计 每一家诊所。第二阶段将包括CCI的开发。我们将进行功能测试，并进行 与关键利益攸关方进行了一系列访谈，以了解CCI的反复修订。在第三阶段，我们将培训 CCI中的提供者并评估HIV和SU之间的可行性、可接受性和可持续性潜力 治疗提供者通过试验前、试验后设计分布在两个不同的诊所。数据将在 组织级、提供者级和患者级。与两家诊所实施CCI前相比，我们 预计实施后的数据将导致：(H1)对提供者的护理协调更满意 (H2)提高机构间通信的频率和质量；(H3)加强 机构间专业关系；以及(H4)增加了患者层面的双重护理保留。长的- 长期目标是扩大可持续干预措施的可获得性，以改善艾滋病毒和SU的协调 治疗服务。这项研究的数据将成为今年初未来多站点R01提案的基础 职业，新的调查员申请者。

Project Summary/Abstract Drug use is associated with poor linkages to HIV care, reduced retention in care, increased sexual risk behavior, and decreased adherence to medications, leading to inferior clinical outcomes, and increased HIV transmission. HIV-infected people who use drugs (HPWUD) have higher rates of co-occurring psychiatric and medical diagnoses, resulting in increased utilization of services. Many structural and systemic barriers impede the integration of treatment for HIV and substance use (SU). The use of a mobile application combined with an evidence-based training model offers an innovative approach to improving care coordination and linking patients to care in need of dual treatment. A mhealth application delivered via tablet device provides a unique channel to link HIV and SU treatment providers located at off-site clinics. This study will be a Stage I pilot and feasibility study that will be the first to use a theory-based model of care coordination to develop a Care Coordination Intervention (CCI) for treatment providers serving HPWUD. The proposed study seeks to develop a secure mobile technology platform that will: (a) enable rapid communication among providers at multiple clinics, (b) improve linkage to dual care, and (c) improve coordination of patient services. The CCI will also utilize an evidence-based training model to increase provider knowledge in relevant HIV, PrEP, and SU issues. The proposed method of integrating dual care for patients is expected to be an efficient and easily disseminable platform for integrating HIV/SU care that will facilitate communication between providers at multiple clinics and allow for efficient management of patient treatment referrals and service utilization. This project will examine acceptability, feasibility, and sustainability potential using mixed-methods. A three-phase, top-down research approach to adapt, refine, and pilot test the intervention will be conducted. Phase 1 will include individual interviews with key stakeholders and audits of referral and communication processes within each clinic. Phase 2 will include development of the CCI. We will conduct a functionality test and conduct a series of interviews with key stakeholders to inform iterative revision of the CCI. During Phase 3, we will train providers in the CCI and evaluate the feasibility, acceptability, and sustainability potential among HIV and SU treatment providers located at two different clinics via a pre-, post-test design. Data will be gathered at the organizational-, provider-, and patient-levels. Compared to pre-implementation of the CCI in both clinics, we expect that post-implementation data will result in: (H1) greater satisfaction of care coordination at the provider level; (H2) increased frequency and improved quality of interagency communications; (H3) enhanced interagency professional relationships; and (H4) increased dual care retention at the patient level. The long- term goal is to expand the availability of sustainable interventions to improve coordination of HIV and SU treatment services. Data from this research will form the basis of a future multisite R01 proposal for this early career, new investigator applicant.