Improving the Integration of Mental Health and Substance Use Treatment into Ryan White-Funded Care Sites in Atlanta using an Implementation Science Approach

项目总结/摘要 作为对RFA-MH-20-521的回应，本R34申请建议调整减少耻辱的培训， 新的处方平台，并试点测试这些实施策略，以改善整合 瑞安白色护理中心严重精神健康障碍和酒精使用障碍（AUD）的药物治疗， 结束流行病计划的三个县--亚特兰大市区的Dekalb、Gwinnett和Cobb县。 我们建议成立一个社区合作委员会，其中包括艾滋病毒感染者， 对艾滋病毒感染者进行深入访谈，以调整卫生政策项目的减少耻辱培训， 精神健康和与滥用药物有关的污名。我们还将聘请一个精神病专家小组， 艾滋病毒医学专家，并与提供者进行重点小组讨论， 您可以使用Decision处方平台，帮助提供者做出关于处方药物的决定， 抑郁症，创伤后应激障碍，双相情感障碍，并在艾滋病毒感染者的AUD。该平台将通过移动的设备访问- 智能手机和平板电脑，并将使用基于艾滋病毒初级保健最佳实践的算法， 艾滋病毒医学和精神病学专家的反馈，以指导艾滋病毒提供者制定最佳方案， 共病患者的药物治疗方案。对于这项规划补助金，我们将使用综合 实施研究框架、ERIC建议和普罗克特的实施分类法， 探讨执行的决定因素，确定执行战略，并评估 减少耻辱的培训，并评估的可行性和可接受性，你的决定处方平台， 积极影响健康中心，这是瑞安怀特资助的护理网站。我们亦会进行试验计划， 评估减少污名培训的初步影响，以减少临床层面的污名和你的决定 处方平台，以提高提供者与精神病药物处方相关的自我效能， 纳洛酮（靶向机制）及其对抑郁症、创伤后应激障碍、双相情感障碍、 AUD（收养）具体目标：目标1：与艾滋病毒感染者、艾滋病毒护理提供者、 和我们的CCB，以适应减少耻辱的培训，以解决心理健康和药物滥用有关的 在诊所工作人员之间的耻辱和从事艾滋病毒护理提供者和专家小组，以制定你的决定 处方平台，以支持艾滋病毒护理提供者提供药物治疗抑郁症，创伤后应激障碍， 躁郁症和AUD。目的2：评估减少污名培训在临床中的可接受性 工作人员和可行性，可接受性，并采用使用您的决策处方平台期间， 在艾滋病毒护理环境中提供者的临床接触。目标3：用具体的方法进行 试点试验，以评估减少污名培训对诊所一级污名的初步影响， 关于艾滋病护理提供者开精神病药物的自我效能的You Decision处方平台 以及减少耻辱的培训和平台的影响，以增加百分比 接受抑郁症、创伤后应激障碍、双相情感障碍和AUD治疗处方的合格患者。

PROJECT SUMMARY/ABSTRACT In response to RFA-MH-20-521, this R34 application proposes to adapt a stigma-reduction training, develop a new prescribing platform, and pilot test these implementation strategies to improve the integration of pharmacotherapy for serious mental health disorders and alcohol use disorder (AUD) in Ryan White care sites in three counties of the Ending the Epidemic Plan—Dekalb, Gwinnett, and Cobb Counties in the Atlanta Metro area. We propose to engage a Community Collaborative Board (CCB) that includes people living with HIV (PLHIV) and conduct in-depth interviews with PLHIV to adapt the Health Policy Project's stigma-reduction training to address mental health and substance abuse-related stigma. We also will engage an expert panel of psychiatrists and experts in HIV medicine and conduct focus group discussions with providers to inform the development of the You℞ Decision prescribing platform, which will help providers make decisions about prescribing medications for depression, PTSD, bipolar disorder, and AUD among PLHIV. This platform will be accessible via mobile devices— smartphones and tablets—and will use algorithms based on best practices in HIV primary care and refined based on feedback from experts in HIV medicine and psychiatry to guide HIV providers in developing the best medication regimens for patients with comorbid disorders. For this planning grant, we will use the Consolidated Framework for Implementation Research, the ERIC recommendations, and Proctor's implementation taxonomy to explore the determinants of implementation, identify implementation strategies, and assess the acceptability of the stigma-reduction training and assess feasibility and acceptability of the You℞ Decision prescribing platform in Positive Impact Health Centers, which are Ryan White-funded care sites. We will also conduct a pilot trial to assess the preliminary impact of the stigma-reduction training to reduce clinic-level stigma and the You℞ Decision prescribing platform to increase providers' self-efficacy related to prescribing psychiatric medication and naltrexone (targeted mechanisms) and their provision of pharmacotherapy for depression, PTSD, bipolar disorder, and AUD (adoption). Specific Aims: Aim 1: To conduct formative activities with PLHIV, HIV care providers, and our CCB to adapt a stigma-reduction training to address mental health and substance abuse-related stigma among clinic staff and engage HIV care providers and an expert panel to develop the You℞ Decision prescribing platform to support HIV care providers to offer pharmacotherapy to treat depression, PTSD, bipolar disorder, and AUD. Aim 2: To assess the acceptability of the stigma-reduction training among clinic staff and the feasibility, acceptability, and adoption of using the You℞ Decision prescribing platform during clinical encounters among providers in HIV care settings. Aim 3: To use idiographic methods to conduct a pilot trial to assess the preliminary impact of the stigma-reduction training on clinic-level stigma and of the You℞ Decision prescribing platform on HIV care providers' self-efficacy to prescribe psychiatric medications and naltrexone as well as the impact of the stigma-reduction training and platform to increase the percentage of eligible patients who receive prescriptions to treat depression, PTSD, bipolar disorder, and AUD.