Feasibility of SBIRT for Underserved HIV+ Adults 50+ in Primary Care Settings

 描述（由申请人提供）：这个指导以患者为导向的研究职业发展奖（K23）的目标是支持博士妮可恩尼斯怀特黑德，临床心理学家，在发展必要的关键技能，成为一个独立的研究人员在实施物质使用干预在真实的世界设置。她寻求获得技能：4个领域：物质使用干预科学，实施科学，混合方法和研究行为国家药物滥用研究所（NIDA）和艾滋病研究办公室（OAR）都优先考虑促进将基于证据的干预措施纳入现实世界环境的研究。现有文献表明，20-50%的老年人 艾滋病毒滥用酒精，非法药物或处方药。需要对这一人群采取干预措施。迄今为止，许多有效的干预措施并没有转化为改善患者护理的有意义的结果。特别是物质使用干预措施在从研究实验室到现实世界环境（初级保健诊所，社区治疗中心等）的转变中滞后。筛查、短期干预和治疗（SBIRT）模式在减少烟草、酒精和非法药物使用等高危行为方面有效。然而，最近的数据表明，简单的干预模式本身可能对弱势群体无效。支持SBIRT的证据表明，其他模型，如SBIRT与同行导航（SBIRT-PN），应检查该人群。因此，该K23的培训目标是提高候选人在艾滋病毒初级保健诊所为50岁及以上的艾滋病毒阳性成人实施SBIRT-PN的技能。培训目标包括：（1）描述和区分物质使用干预与弱势群体的最佳方法;（2）获得在现实世界中实施物质使用干预的技能;（3）获得先进的干预建模和混合方法研究的技能，并使用这些方法来评估物质使用干预。这些研究目标的执行沿着全面的培训计划将由罗伯特库克博士，琳达B。Cottler和Xinguang Chen博士与其他合作者一起解决培训的具体需求。该研究项目将使用范围，有效性，采用，实施和维护（RE-AIM）框架，使用南方艾滋病毒和酒精研究联盟（SHARC）艾滋病毒初级保健诊所网络对SBIRT-PN进行试点和评估。目标1：SBIRT-PN与HIV初级保健诊所常规治疗相比的试点有效性，以改善50岁及以上成人的药物使用治疗参与和HIV预约依从性。目的2：描述人口统计学因素，抑郁和疼痛对物质使用治疗参与结果的影响。目标3：检查和提高可行性（招募，剂量，保留）的干预措施吸收一个更大的试验。拟议的研究将提供所需的初步数据，以支持R 01测试在广泛的临床网络中实施这种干预措施（SBIRT-PN），为老年HIV+成人提供服务。完成本计划将为我的职业生涯做好准备，作为一名独立的临床调查员，接受培训，在真实的世界环境中实施物质使用干预。

 DESCRIPTION (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to support Dr. Nicole Ennis Whitehead, a Clinical Psychologist, in developing the critical skills necessary to become an independent researcher in the implementation of substance use interventions in real world settings. She seeks to acquire skills in: 4 areas: substance use intervention science, implementation science, mixed methods, and research conduct Both the National Institute on Drug Abuse (NIDA) and the Office of AIDS Research (OAR) have prioritized research that promotes the uptake of evidence based interventions into real-world settings. Extant literature indicates that 20-50% of those aging with HIV misuse alcohol, illicit drugs or prescription medications. Interventions that reach this population are needed. To date many effective interventions do not translate into meaningful outcomes that improve patient care. Substance use interventions in particular have lagged in moving from research laboratories to real-world settings (primary care clinics, community treatments centers, etc.). The Screening, Brief Intervention and Treatment (SBIRT) model has been effective in decreasing high risk behaviors such as tobacco, alcohol, and illicit drug use. However, recent data suggests that brief intervention models alone may not be effective with vulnerable populations. The evidence supporting SBIRT indicates that other models such as SBIRT with a peer navigator (SBIRT-PN) should be examined for this population. Therefore, the training goal for this K23 is to advance the candidate's skills in implementing SBIRT-PN in HIV primary care clinics for HIV+ adults 50 and older. Training aims include: (1) Describe and differentiate optimal methods of substance use intervention with vulnerable populations; (2) Obtain skills to implement substance use interventions in real-world settings; and (3) Acquire skills in advanced intervention modeling and mixed methods research and use these methods to evaluate substance use interventions. Execution of these research aims along with a comprehensive training program will be led by Dr. Robert Cook, Dr. Linda B. Cottler and Dr. Xinguang Chen with additional collaborators to address training specific needs. The research project will use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to pilot and evaluate the SBIRT-PN using the Southern HIV and Alcohol Research Consortium (SHARC) HIV primary care clinic network. Aim 1: Pilot effectiveness of SBIRT-PN versus treatment as usual in HIV primary care clinics to improve substance-use treatment engagement and HIV appointment adherence among adults aged 50 and older. Aim 2: Describe the influence of demographic factors, depression and pain on substance-use treatment engagement outcomes. Aim 3: Examine and enhance feasibility (recruitment, dose, retention) of intervention uptake for a larger trial. The proposed research will provide the preliminary data needed to support an R01 testing the implementation of this intervention (SBIRT-PN) across a broad clinical network serving older HIV+ adults. Completion of this plan will prepare me for a career as an independent clinical investigator trained to implement substance use interventions in real world settings.