Center for HIV Identification, Prevention and Treatment Services (CHIPTS) - EHE Supp: Implementation of an Emergency Department HIV/SUD screening and treatment referral mHealth tool for Latino patient

摘要 这一补充申请旨在在尚未达成的地理区域建立新的合作伙伴关系 目前的努力。这一地区由河滨和圣贝纳迪诺两个优先县组成，统称为 名为内陆帝国。该地区有超过14,000名艾滋病毒携带者，未确诊的比例 感染率仍然相对较高(18%)，并保持不变。未被识别的艾滋病毒感染是背后的驱动力 2014-2018年间新诊断的艾滋病毒病例增加了23%，因为80%的新艾滋病毒感染病例可以追踪到 给未确诊或无人看护的个人。艾滋病毒在内陆帝国的流行不成比例地影响 在这些新确诊的艾滋病毒感染者中，有79%是非白人。物质使用 疾病(SUD)是艾滋病毒在拉丁裔人群中传播的重要驱动因素，占三分之一 这一组中新增艾滋病毒病例的比例。拉丁裔患者更有可能在紧急情况下使用医疗保健，这表明 在急诊科(ED)寻求治疗的大量拉丁裔患者可能没有得到诊断 HIV感染和并发SUD。洛玛琳达大学(LLU)ED是全美唯一的一级创伤中心 内陆帝国。它是整合HIV和SUD服务以及筛选和转介拉丁裔的理想场所 病人需要照顾。在急诊室扩大艾滋病毒筛查是疾控中心PS20中描述的关键战略之一- 2010年，支持内陆帝国的EHE项目。这也是当地公众确定的战略优先事项。 卫生部门。作为回应，这项研究将适应并试行现有的基于计算机的自我筛选 采取干预措施，确定有HIV风险和/或与SUD相关的HIV风险的拉丁裔ED患者。这场放映将是 由社区卫生工作者(CHW)协助。代表目标病人人口的健康护理小组将会 接受艾滋病毒检测顾问的培训。他们将为高危患者提供快速艾滋病毒检测，要求进行检测后 咨询，以及与适当的护理资源的联系。这项建议将以探索为指导， 准备、实施和维持(EPIS)模型。研究小组将进行教育署评估 在探索阶段，确定实施筛查干预的促进者和障碍。 在准备阶段，研究人员将在多个项目的帮助下调整现有的筛查干预措施 纪律小组每周开会，为期三个月。实施合作伙伴将培训CHW并准备 LLU ED进行了干预的试点测试。实施阶段将试点测试干预措施，重点是 关于它的可接受性和接触到处于危险中的拉丁裔人口的潜力。可持续发展阶段将探索 更广泛的评估研究的可行性和在LLU采用这种筛查干预的意图 艾德。将评估下列执行成果：执行的可行性和可接受性 LLU ED中的健康HIV/SUD筛查，这项干预措施在患者和 临床医生，有意采取这种干预措施。这些数据将用于更广泛的评价研究。

Abstract This supplemental application aims to establish a new partnership in the geographic area not yet reached by current EHE efforts. This area consists of two EHE priority counties – Riverside and San Bernardino, collectively called Inland Empire. More than 14,000 individuals live with HIV in the area, and the proportion of undiagnosed infections remains relatively high (18%) and unchanged. Unrecognized HIV infection is the driving force behind the 23% increase in new HIV diagnoses between 2014-2018, as 80% of these new HIV infections can be traced to undiagnosed or out of care individuals. The HIV epidemic in the Inland Empire disproportionately impacts minority populations, as 79% of these new HIV diagnoses were among non-white individuals. Substance use disorder (SUD) is a significant driver of HIV transmission among Latino population, being the cause of one third of new HIV cases in this group. Latino patients are more likely to use health care in emergencies, which suggests a significant number of Latino patients seeking care in the emergency departments (ED) may have undiagnosed HIV infection and concurrent SUD. Loma Linda University (LLU) ED is the only Level 1 Trauma Center in the Inland Empire. It represents an ideal place to consolidate HIV and SUD services and to screen and refer Latino patients to care. Expanding HIV screening in EDs is one of the critical strategies described under the CDC PS20- 2010, supporting EHE programs in the Inland Empire. This is also a strategic priority identified by the local public health departments. In response, this study will adapt and pilot-test an existing computer-based self-screening intervention to identify Latino ED patients with HIV risk and/or SUD-related HIV risk. This screening will be facilitated by community health workers (CHWs). The CHWs, representing the target patient demographic, will be trained as HIV test counselors. They will provide rapid HIV tests to at-risk patients, required post test counseling, and linkage to appropriate care resources. This proposal will be guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) model. The study team will conduct an ED assessment during the Exploration phase to determine facilitators and barriers to implementing screening intervention. During the Preparation phase, researchers will adapt the existing screening intervention with the help of a multi- disciplinary group meeting weekly for three months. The implementation partners will train CHWs and prepare the LLU ED for a pilot test of the intervention. The Implementation phase will pilot test the intervention, focusing on its acceptability and potential to reach the at-risk Latino population. The Sustainment phase will explore the feasibility of a more extensive evaluation study and the intention to adopt this screening intervention in the LLU ED. The following implementation outcomes will be assessed: feasibility and acceptability of implementing mHealth HIV/SUD screening in the LLU ED, reach and acceptability of this intervention among patients and clinicians, intention to adopt this intervention. This data will be used to inform a more extensive evaluation study.