Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for PLWH who use drugs

项目摘要 吸毒的艾滋病毒感染者是艾滋病毒连续护理中最脆弱的群体， 表现出低的护理保留率和差的临床结果。艾滋病毒和丙型肝炎（HCV）经常同时发生 由于共同的脆弱性和传播途径，包括注射吸毒，这也与艾滋病毒/艾滋病有关。 有阿片类药物过量的风险使用药物的艾滋病毒携带者在医疗保健中经历了预期和实施的耻辱 这导致了不良的临床结果。减少伤害（HR）是一种旨在减少 危险健康行为的负面影响，而不一定完全消除它们， 让吸毒者参与护理的有效方式。虽然通常被认为是结构性方法， 例如注射器服务，减少伤害也是一种关注非惩罚性的护理的关系方法， 在患者和提供者之间建立良好的关系。本R 01将探讨 结构性和关系性人力资源方法，以缓冲艾滋病毒感染者吸毒者的污名经历 初级保健设置和改善病人与提供者的关系以及临床结果的质量。的 研究将探讨医疗服务提供者对与使用药物的艾滋病毒携带者合作的态度，以及 这些都涉及到他们的接受和实践的结构和关系的人力资源。这将是通过网络完成， 基于调查（n=125）和定性访谈（n=20）与匹兹堡，宾夕法尼亚州和 这些方法将利用多层次的透镜，吸引多个提供商类型，如社交网络， 工作人员，护士和医生在艾滋病毒初级保健团队工作。利用交叉性框架， 这项研究还将评估患者对其艾滋病毒提供者的人力资源护理的看法与艾滋病毒感染的程度 与艾滋病毒初级保健环境中预期和实施的耻辱和临床结果有关。数据将 通过调查使用药物的PLWH（n=500）收集，以探索结构和关系HR是否减轻了污名， 改善患者-提供者关系，并最终改善通过电子测量的临床结果 健康记录数据，包括HIV病毒载量、HIV初级保健的保留率、HCV持续病毒学应答， 阿片类药物使用障碍和/或行为障碍的药物依从性和护理保留 物质使用障碍健康治疗。研究方法将包括对心理测量的评估。 提供者伤害减少量表（PAPHRS）的患者评估属性，这是一种新的量表， HR关怀。最后，本研究将应用以人为本的设计方法，让利益相关者参与 审查提供者和患者的人力资源护理经验的结果，以制定干预措施， 在艾滋病毒初级保健环境中实施人力资源护理。初步探讨了该方法的可行性、可接受性， 和适当的新开发的干预措施将进行与艾滋病毒提供者。最终这 研究轨迹旨在改善吸毒者对护理的坚持和健康差异。

Project Summary People living with HIV (PLWH) who use drugs are among the most vulnerable in the HIV continuum of care, exhibiting low rates of retention in care and poor clinical outcomes. HIV and hepatitis C (HCV) often co-occur due to shared vulnerabilities and routes of transmission including injection drug use, which is also associated with risk for opioid overdose. PLWH who use drugs experience anticipated and enacted stigma in healthcare settings, which contribute to poor clinical outcomes. Harm reduction (HR) is an approach that aims to reduce the negative effects of risky health behaviors without necessarily eliminating them completely and is an effective way of engaging people who use drugs into care. Though often thought of as structural approaches, such as syringe services, harm reduction is also a relational approach to care that focuses on non-punitive, autonomy-building relationships between patients and providers. This R01 will explore the degree to which structural and relational HR approaches to care buffer experiences of stigma for PLWH who use drugs in HIV primary care settings and improve the quality of patient-provider relationships as well as clinical outcomes. The study will explore healthcare providers' attitudes towards working with PLWH who use drugs and the ways these relate to their acceptance and practice of structural and relational HR. This will be accomplished via web- based surveys (n=125) and qualitative interviews (n=20) with healthcare providers in Pittsburgh, PA and Birmingham, AL. These methods will utilize a multi-level lens, engaging multiple provider types, such as social workers, nurses, and physicians working in HIV primary care teams. Using an intersectionality framework, the study will also assess the degree to which patients' perceptions of their HIV providers' HR care are associated with anticipated and enacted stigma in HIV primary care settings and with clinical outcomes. Data will be collected by surveying PLWH who use drugs (n=500) to explore if structural and relational HR mitigate stigma, improve the patient-provider relationship, and ultimately improve clinical outcomes as measured via electronic health records data including HIV viral load, retention in HIV primary care, HCV sustained virologic response, medication adherence, and retention in care for Medications for Opioid Use Disorder and/or in behavioral health treatment for substance use disorder. Study methods will include an evaluation of the psychometric properties of the Patient Assessment of Providers Harm Reduction Scale (PAPHRS), a novel scale to measure relational HR care. Finally, the study will apply human-centered design approaches to engage stakeholders in reviewing findings from providers' and patients' experiences of HR care to develop an intervention to operationalize HR care in HIV primary care settings. A preliminary exploration of the feasibility, acceptability, and appropriateness of the newly-developed intervention will be conducted with HIV providers. Ultimately this research trajectory aims to improve adherence to care and health disparities for PLWH who use drugs.