Implementation of a triadic network case management intervention for younger Black sexual minority men

我们将进行一个病例的混合II型有效性-实施随机对照试验 管理二元(CM2)干预，一种基于证据的三元社会工作干预，使用案例 经理二人将聘请18-35岁的年轻黑人性少数族裔男性(YBSMM)保持经济稳定 服务。CM2通过以下方式创新现有的护理连续参与模式：(1)确定资源咨询的优先顺序 改善艾滋病毒护理和预防的连续成果，以及(2)利用三元网络方法，其中 客户与一个并行式的案例管理团队会面-与客户组成三合会-该团队提供 为客户和案例经理提供其他支持。Cm2是及时的，因为密集的干预是 对于吸引那些没有从现有的零工作中受益的社区成员来说至关重要。Cm2将 还要测试稳健的实施策略，以支持CM2实施并提高专业水平 发展和预防艾滋病毒一线工作人员的倦怠，他们中的一些人直接受到艾滋病毒的影响。 CM2干预措施和相关的实施战略产生于 调查小组。我们将在这些经验、基础设施和关系的基础上评估 CM2在N=180 YBSMM中的有效性和实施数据收集，在基线上，每隔6 18个月以上，将包括调查和电子病历数据。为了研究执行情况，我们 将使用实施研究综合框架作为决定性框架和RE-AIM 作为评价框架。具体目标是：(目标1a)评价初级(经济福利、粮食) 安全性)和二次(集成PrEP持久性/病毒负载抑制)与常规的有效性 Ryan White在YBSMM中的非医疗病例管理和PrEP资源咨询；(目标1b)。 评估有效性(成功完成资源推荐所需的时间、CM工作满意度、CM职业倦怠和 客户关系)CM2干预与常规Ryan White案例管理和/或PrEP资源 向个案管理人研究参与者提供咨询；(目标2a)确定财务福利的程度 食品安全调节CM2和下游18个月综合护理连续体之间的关系 结果；(目标2b)探索CM2对初级(资源)和次级(保健)的潜在差异影响 连续)结果，基于精神健康、药物使用、住房、就业和艾滋病毒血清状况；以及 (目标3)使用RE--评估YBSMM和案例经理两个级别的实施战略和成果 目的研究REACH、采用、实施和维护。实施策略包括个人 和二元式监督、团队协商和培训者培训模式，以及实施结果 可接受性、可行性、适当性、可行性、保真度和成本。如果成功，CM2将加强现有的 案例管理资源支持系统，这不仅将影响YBSMM的生活和护理连续性， 而且还履行了结束艾滋病疫情的优先事项，即重振和维持艾滋病毒前线劳动力。

We will conduct a Hybrid Type II effectiveness-implementation randomized controlled trial of a Case Management Dyad (CM2) intervention, an evidence-based triadic social work intervention that uses a case manager dyad to engage younger Black sexual minority men (YBSMM) aged 18-35 in economic stability services. CM2 innovates on existing care continuum engagement models by (1) prioritizing resource counseling to improve HIV care and prevention continuum outcomes, and (2) utilizing a triadic network approach where a client meets with a dyadic case management team in tandem–forming a triad with the client–which provides additional supports for the client and the case managers. CM2 is timely given that intensive interventions are critical for engaging community members who have not benefited from existing Getting to Zero efforts. CM2 will also test robust implementation strategies to support CM2 implementation and to enhance the professional development and prevent burnout in the HIV front-line workforce, some of whom are directly impacted by HIV. The CM2 intervention and associated implementation strategies emerge from prior work conducted by the Investigative Team. We will build upon these experiences, infrastructures, and relationships to evaluate the effectiveness and implementation of CM2 among N=180 YBSMM. Data collection, at baseline, and every 6 months over 18 months, will include surveys and electronic medical record data. To study implementation, we will use the Consolidated Framework for Implementation Research as the determinant framework and RE-AIM as the evaluation framework. The specific aims are to: (Aim 1a) Evaluate the primary (financial well-being, food security) and secondary (integrated PrEP persistence/viral load suppression) effectiveness of CM2 vs routine Ryan White Non-Medical Case Management and PrEP Resource Counseling among YBSMM; (Aim 1b). Evaluate the effectiveness (time to successful resource referral completion, CM job satisfaction, CM burnout and CM-client relationship) of the CM2 intervention vs. routine Ryan White Case Management and/or PrEP Resource Counseling among case manager study participants; (Aim 2a) Determine the extent to which financial well-being and food security mediate the relationship between CM2 and downstream 18-month integrated care continuum outcomes; (Aim 2b) Explore potential differential effects of CM2 on primary (resource) and secondary (care continuum) outcomes, based on mental health, substance use, housing, employment and HIV serostatus; and (Aim 3) Evaluate implementation strategies and outcomes at both YBSMM and case manager levels using RE- AIM to study reach, adoption, implementation, and maintenance. Implementation strategies include individual and dyadic supervision, team consultation, and a train-the-trainer model, and implementation outcomes are acceptability, feasibility, appropriateness, feasibility, fidelity and cost. If successful, CM2 will intensify existing case management resource support systems, which will not only impact the lives and care continua of YBSMM, but also fulfill an ending the epidemic priority of revitalizing and sustaining the HIV frontline workforce.