A Cluster RCT to Increase HIV Testing in Substance Use Treatment Programs

项目摘要/摘要 在美国，大约八分之一的艾滋病毒携带者没有意识到自己的感染，而大多数人 美国成年人从未接受过艾滋病毒检测。疾控中心和世卫组织呼吁在#年扩大艾滋病毒检测 高危人群接受健康服务的环境，包括阿片类药物治疗计划。 与普通人群相比，使用阿片类药物和其他物质的人感染艾滋病毒的风险较高；然而 不到一半的美国物质使用障碍(SUD)治疗计划提供现场艾滋病毒检测和 在过去十年中，这样做的OTP比例有所下降。人们普遍认识到有必要 增加艾滋病毒检测和现场艾滋病毒检测在SUD治疗中的有效性和经济价值 程序已经演示过了。美国预防服务工作组最近提出的建议 (USPSTF)应该在卫生保健环境中对青少年和成年人进行艾滋病毒筛查，这提供了新的 扩大OTP中艾滋病毒检测的机会。要优化此机会，OTP必须满足 并克服组织层面的检测障碍，包括人员配备、培训、对艾滋病毒传播的担忧 检测结果和与护理的联系，以及需要建立支持艾滋病毒检测报销的制度 服务。此外，丙型肝炎(丙型肝炎)检测被一些南德人认为是更大的需要 程序。丙型肝炎病毒感染率在阿片类药物使用者中很高，高于艾滋病毒流行率和更多患有 慢性丙型肝炎病毒感染者并不知道自己受到了感染。因此，我们将审查是否提供丙型肝炎病毒检测 与艾滋病毒检测相结合将是采用和实施艾滋病毒检测的动力。在这方面，3- ARM集群-51个OTP的RCT将用于测试2个以证据为基础的积极“练习教练”(PC) 采取干预措施，改进提供和持续实施1)艾滋病毒检测以及与护理和保健的联系 2)联合艾滋病毒/丙型肝炎病毒检测和OTP患者的联动护理。在PC中，变革推动者和OTP关键员工 提供培训和支持，以促进创新的实施和由此产生的改进。 具体目标是：目标1：评估PC干预措施在改善患者摄取 OTP中的艾滋病毒检测，包括艾滋病毒/丙型肝炎病毒干预对艾滋病毒检测的增量影响。目标2：实现 使用混合方法审查个人计算机干预措施对启动和持续提供 艾滋病毒检测与护理及时联动。目标3：评估健康结果、卫生保健利用情况和 PC干预措施的成本-效果递增地相互比较，并与控制条件进行比较。 这将是第一次测试增加艾滋病毒和艾滋病毒/丙型肝炎病毒检测和联系的组织方法的研究 在OTPS患者中进行护理。这项提议与美国国立卫生研究院针对艾滋病毒/艾滋病的新的优先事项保持一致 研究。第一要务是减少艾滋病毒/艾滋病的发病率，重点之一是开发、检测和 实施改进艾滋病毒检测和提供预防服务的战略。

Project Summary/Abstract Approximately one in eight people living with HIV in the US are unaware of their infection and the majority of adults in the US have never been HIV tested. The CDC and WHO have called for expanding HIV testing in settings where high-risk persons receive health services, including opioid treatment programs (OTPs). Persons who use opioids and other substances have high HIV risk compared with the general population; yet fewer than half of US substance use disorder (SUD) treatment programs offer on-site HIV testing and the proportion of OTPs that do has declined in the past decade. There is widespread recognition of the need for increased HIV testing and the effectiveness and economic value of on-site HIV testing in SUD treatment programs has been demonstrated. Recent recommendations from the US Preventive Services Task Force (USPSTF) that adolescents and adults should be screened for HIV in health care settings provide new opportunities for expanding access to HIV testing in OTPs. To optimize this opportunity, OTPs must address and overcome organizational-level barriers to testing, including staffing, training, concerns about delivering HIV test results and linkage to care, and the need to set up systems to support reimbursement for HIV testing services. Additionally, Hepatitis C (HCV) testing is perceived as an even greater need by some SUD programs. HCV prevalence, high among opioid users, is higher than HIV prevalence and more individuals with chronic HCV infection are unaware of their infection. Thus, we will examine whether the offer of HCV testing with HIV testing would be a motivator for adoption and implementation of HIV testing. Within this context, a 3- arm cluster-RCT of 51 OTPs will be used to test 2 active evidence-based “practice coaching” (PC) interventions to improve the provision and sustained implementation of 1) HIV testing and linkage to care and 2) joint HIV/HCV testing and linkage to care among OTP patients. In PC, change agents and key OTP staff are provided training and support to facilitate the implementation of innovation and sustain resulting improvements. Specific aims are: Aim 1: To evaluate the effectiveness of the PC interventions on improving patient uptake of HIV testing in OTPs including the incremental impact of the HIV/HCV intervention on HIV testing. Aim 2: To examine, using mixed-methods, the impact of the PC interventions on the initiation and sustained provision of HIV testing and timely linkage to care. Aim 3: To evaluate the health outcomes, health care utilization, and cost-effectiveness of the PC interventions compared incrementally to one another and to the control condition. This will be the first study to test organizational approaches to increase HIV and HIV/HCV testing and linkage to care among patients in OTPs. This proposal is aligned with the new NIH-wide priorities for HIV/AIDS research. The first priority is to reduce HIV/AIDS incidence and one of the main points is to develop, test, and implement strategies to improve HIV testing and entry into prevention services.