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

项目总结/摘要 在美国，大约八分之一的艾滋病毒感染者不知道自己感染了艾滋病毒， 美国的成年人从未接受过艾滋病毒检测。疾病预防控制中心和世卫组织呼吁扩大艾滋病毒检测， 高危人群接受卫生服务的环境，包括阿片类药物治疗计划（OTP）。 与一般人群相比，使用阿片类药物和其他药物的人感染艾滋病毒的风险很高;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， 在过去十年中，这样做的在线旅行社的比例有所下降。人们普遍认识到， 增加艾滋病毒检测以及现场艾滋病毒检测在SUD治疗中的有效性和经济价值 方案得到了论证。美国预防服务工作组的最新建议 （USPSTF），青少年和成年人应该在卫生保健环境中进行艾滋病毒筛查， 扩大艾滋病毒检测的机会。为了优化这一机会，OTP必须解决 并克服组织层面的检测障碍，包括人员配备、培训、对提供艾滋病毒的担忧 艾滋病毒检测结果及其与护理的联系，以及建立艾滋病毒检测报销制度的必要性 服务此外，丙型肝炎（HCV）检测被认为是一些SUD更大的需求 程序.在阿片类药物使用者中，HCV的流行率很高，高于艾滋病毒的流行率， 慢性HCV感染者不知道他们的感染。因此，我们将研究是否提供HCV检测 艾滋病毒检测将成为采用和实施艾滋病毒检测的动力。在这方面，一个3- 将使用51个OTP的随机对照试验（RCT）来测试2种基于证据的主动“实践指导”（PC） （a）采取干预措施，以改善以下服务的提供和持续实施：1）艾滋病毒检测和与护理的联系， 2)在OTP患者中进行艾滋病毒/丙型肝炎病毒联合检测并与护理挂钩。在PC中，变革推动者和关键的OTP工作人员是 提供培训和支持，以促进创新的实施，并维持由此产生的改进。 具体目标是：目标1：评价PC干预措施在改善患者对 艾滋病毒检测在OTP，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： 检查，使用混合方法，PC干预对启动和持续提供的影响 艾滋病毒检测和及时的护理联系。目的3：评估健康结果、卫生保健利用和 PC干预措施的成本效益相互之间以及与对照条件之间进行递增比较。 这将是第一项测试组织方法的研究，以增加艾滋病毒和艾滋病毒/丙型肝炎病毒检测和联系 来照顾门诊病人该提案与NIH范围内新的艾滋病毒/艾滋病优先事项保持一致 research.首要任务是降低艾滋病毒/艾滋病发病率，其中一个要点是开发、检测和 执行各项战略，改善艾滋病毒检测和接受预防服务的情况。

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.