Advance Care Coordination and Enhanced Linkage and Retention Among Transitional Re-Entrants Living with Hepatitis C-The HCV-ACCELERATE Trial

摘要 这项研究的首要目标是制定和测试一项创新战略，以改善联系 最近从监狱释放的人中丙型肝炎病毒（HCV）治疗的持续时间。博士 Matthew Akiyama提出了K99/R 00职业发展和研究计划，这将使他做好准备， 制定干预措施，改善刑事司法人员与HCV护理的联系和保留 系统参与。在美国，HCV是导致肝硬化和肝细胞癌的主要原因 到2007年，它取代了艾滋病成为死亡原因。与物质使用障碍有很强的相互关系 导致了HCV在教养机构中的流行比例，其患病率为17.4%， 全国HCV感染率仅为1.3%。护理协调方案改善了艾滋病毒+患者与护理的联系 个人离开惩教机构，但没有前瞻性研究评估的战略， 为离开教养机构的丙肝病毒阳性者提供协调。此外，虽然对等体已用于 多样化的环境，以解决医疗保健的障碍，并有效地增加健康知识，减少 危险行为，促进与卫生保健的联系，尚未研究HCV+的同伴干预 离开教养机构的人。秋山博士一直是一个关键的贡献者，以发展一个护理 目前正在纽约进行的一项旨在改善与HCV治疗联系的协调干预 市监狱系统。这项建议以这一经验为基础，并在几个重要方面加以推广。的目标 本建议的指导（K99）阶段是为Akiyama博士提供四项关键技能的充分培训：1） 先进的定性/混合方法研究，2）制定行为干预措施，3）设计和实施 的随机对照试验在矫正设置，和4）纵向和集群的统计分析， 专门针对刑事司法人员的数据。在该奖项的指导（K99）阶段，我们将实现 以下具体目标：1）确定现有HCV中与护理联系的障碍和促进因素 护理协调计划和2）使用目标1中确定的障碍和促进因素来设计一个 以同龄人为核心组成部分的强化、量身定制的护理协调干预措施。在 独立R 00阶段的奖励，我们将3）测试同行的可行性和有效性- 使用随机设计的增强的、量身定制的护理协调干预。我们假设 量身定制的干预措施，由同行加强，将导致更大的联系率与HCV治疗，治疗 启动、治疗完成、持续的病毒学应答和较低的HCV风险行为率。 在R 00阶段完成拟议的试点试验沿着在K99期间进行强化指导 Akiyama博士将准备在多地点测试同伴增强护理协调干预 未来R 01中的随机对照试验。拟议的K99/R 00奖将提供培训，指导， 研究经验，将作为秋山博士的职业生涯作为一个独立资助的基础。 致力于改善刑事司法系统中HCV+个体的健康结果的临床研究者 参与。

ABSTRACT The overarching goal of this research is to develop and test an innovative strategy to improve linkage to and retention in hepatitis C virus (HCV) treatment among individuals recently released from jail. Dr. Matthew Akiyama is proposing a K99/R00 career development and research plan which will prepare him to develop interventions to improve linkage to and retention in HCV care among individuals with criminal justice system involvement. HCV is the leading cause of cirrhosis and hepatocellular carcinoma in the United States and, as of 2007, superseded HIV as a cause of death. A strong interrelationship with substance use disorders has led to epidemic proportions of HCV in correctional settings, with a prevalence of 17.4% compared with a national HCV prevalence of only 1.3%. Care coordination programs improve linkage to care among HIV+ individuals leaving correctional settings, yet no prospective studies have evaluated the strategy of care coordination for HCV+ individuals leaving correctional settings. In addition, while peers have been used in diverse settings to address barriers to medical care and are effective at increasing health knowledge, reducing risk behaviors, and facilitating linkage to health care, peer interventions have not been studied for HCV+ individuals leaving correctional settings. Dr. Akiyama has been a key contributor to the development of a care coordination intervention for improving linkage to HCV treatment that is currently underway in the New York City jail system. This proposal builds on this experience and extends it in several important ways. The goal of the mentored (K99) phase of this proposal is to provide Dr. Akiyama with sufficient training in four key skills: 1) advanced qualitative/mixed methods research, 2) developing behavioral interventions, 3) design and conduct of randomized controlled trials in correctional settings, and 4) statistical analysis of longitudinal and clustered data specific to criminal justice populations. During the mentored (K99) phase of the award we will achieve the following specific aims: 1) To identify barriers to and facilitators of linkage to care in an existing HCV care coordination program and 2) To use the barriers and facilitators identified in Aim 1 to design an enhanced, tailored, care coordination intervention with peers as a central component. In the independent R00 phase of the award, we will 3) test the feasibility and effectiveness of the peer- enhanced, tailored, care coordination intervention using a randomized design. We hypothesize that the tailored intervention, enhanced by peers, will lead to greater rates of linkage to HCV treatment, treatment initiation, treatment completion, sustained virologic response, and lower rates of HCV risk behavior. Completion of the proposed pilot trial during the R00 phase along with intensive mentorship during the K99 phase will prepare Dr. Akiyama to test the peer-enhanced care coordination intervention in a multisite randomized controlled trial in a future R01. The proposed K99/R00 award will provide training, mentorship, and research experience that will serve as the foundation for Dr. Akiyama's career as an independently funded clinical investigator dedicated to improving health outcomes for HCV+ individuals with criminal justice system involvement.