Forging sustainable solutions for HIV continuity of care through medical-legal partnerships

项目摘要 损害健康的法律的需要是一个社会问题，对一个人的健康或获得 这一点可以通过法律的照顾和保健相结合得到更好的补救。医疗 法律的伙伴关系作为结构性干预措施没有得到充分利用;但是，它们可以有所帮助 改善卫生保健组织艾滋病毒护理连续性成果。本研究的目的是测试 通过可行性和可接受性试验进行健康生活组织伙伴关系（OPAHL）干预。 OPAHL是一个创新的，多层次的干预包，旨在为人们服务的医疗保健组织 艾滋病毒携带者（PLWH）。它是通过先前的一项研究（授权编号：R21 MH 115820）使用干预开发的 制图方法和社区-科学合作委员会。OPAHL包括：1）培训（7/8小时） 为所有MLP工作人员（临床、社会和行为服务以及法律的）提供关于艾滋病毒持续护理、健康危害 法律的风险和需求，以及MLP结构和运营，以确保一个综合和协作 环境是建立从该计划的最早阶段; 2）案件管理培训的法律的 持续护理; 3）在正规化的案件管理小组会议中嵌入法律的专门知识; 4）共同 在3个月内通过MLP组织间伙伴关系在保健机构提供法律的服务; 和5）组织上有针对性地实施最佳做法交流和信息共享 MLP内的供应商之间的协议，锚定在病人的自主权和选择。具体目标是 研究是：1）完善OPAHL干预原型，用于实施可检测病毒的PLWH 2）检验OPAHL的可行性、可接受性和初步效应量。鉴于目前的 该研究还将探索在以下交叉点应对的MLP机会： 艾滋病毒/艾滋病和COVID-19预防和治疗。两个为费城PLWH服务的医疗保健组织， 目前未向患者提供任何形式的法律的服务的PA将参与本试验（n=200 PLWH）。该研究是对PA-20-141的回应：形成性和试点干预研究， 预防和治疗艾滋病毒/艾滋病（R34临床试验可选）。它还对以下两个领域作出反应： NIMH艾滋病研究部的高优先级研究（开发和测试改善艾滋病毒的干预措施 治疗结果;推进个体以外干预措施的开发和测试 水平）。该项目完成后，将制定一套干预措施， 为艾滋病毒护理受到损害健康的法律的需要影响的高度脆弱人群提供服务。

Project Summary A health-harming legal need is a social problem that adversely affects a person's health or access to health care and which is better remedied through the combination of legal care and health care. Medical legal partnerships (MLPs) have been underutilized as structural interventions; however, they could help improve HIV care continuum outcomes in health care organizations. The goal of this study is to test the Organizational Partnerships for Healthy Living (OPAHL) intervention through a feasibility and acceptability trial. OPAHL is an innovative, multilevel intervention package intended for health care organizations serving people living with HIV (PLWH). It was developed through a prior study (grant #: R21 MH115820) using intervention mapping methodology and community-scientific collaborative boards. OPAHL consists of: 1) training (7/8hours) for all MLP staff (clinical, social and behavioral services, and legal) on HIV continuum of care, health harming legal risks and needs, and MLP structure and operations to ensure that an integrated and collaborative environment is established from the earliest stages of the program; 2) case management training on the legal continuum of care; 3) embedding of legal expertise within regularized case management team meetings; 4) co- location of legal services in health care agencies through MLP inter-organizational partnership within 3 months; and 5) organizationally tailored implementation of best-practice communication and information-sharing protocols among providers within MLP, anchored in patient autonomy and choice. The specific aims of this study are: 1) to refine the OPAHL intervention prototype for implementation with PLWH with detectable viral loads and 2) to test the feasibility, acceptability and preliminary effects sizes of OPAHL. Given the current COVID-19 pandemic, the study will also explore MLP opportunities that respond at the intersection of HIV/AIDS and COVID-19 prevention and treatment. Two health care organizations serving PLWH Philadelphia, PA that do not currently provide any form of legal services to their patients will participate in this trial (n=200 PLWH). The proposed study is in response to PA-20-141: Formative and Pilot Intervention Research for Prevention and Treatment of HIV/AIDS (R34 Clinical Trial Optional). It is also responsive to two of the areas of high priority research of NIMH Division of AIDS Research (Develop and test interventions to improve HIV treatment outcomes; Advance the development and testing of interventions delivered beyond the individual level). Completion of this project will result in the development of an intervention package to optimize HIV services for a highly vulnerable population whose HIV care is affected by health-harming legal needs.