Enhancing integration of HIV and mental health services for young Black gay, bisexual and other men who have sex with men

项目摘要 年轻的黑人同性恋，双性恋和其他与男性发生性关系的男性（YB-GBMSM） 受艾滋病毒影响，在艾滋病毒连续护理（HIV-CoC）中的参与率不佳。心理 健康（MH）合并症导致许多YB-GBMSM的HIV护理参与不足;然而， 这些疾病的治疗受到后勤挑战，医疗不信任和MH等障碍的阻碍 耻辱瑞安白色护理法案支持艾滋病毒和MH服务的整合;然而，我们的初步 研究表明，在感染艾滋病毒的YB-GBMSM中，MH转诊和MH护理参与率较低， 即使是在这些表面上的综合护理环境中。据我们所知， 该项目是专门为改善YB-GBMSM艾滋病毒感染者的MH护理参与而设计的。的目的 R34应用程序是开发和实施CHIMES（跨学科艾滋病毒与心理健康相结合 支持），诊所和提供者一级的干预措施，以改善艾滋病毒-MH护理的整合和MH护理 参加Ryan白色诊所的YB-GBMSM之间的参与。该项目的理由是， 改善服务一体化，特别是如果服务是针对文化的，就有可能增加对生殖健康和艾滋病毒的护理 参与YB-GBMSM。建议的研究将追求两个具体目标：（1）发展CHIMES （2）在两个城市进行CHIMES的第二类混合实施效果试验 HRSA/Ryan White资助的诊所位于格鲁吉亚的亚特兰大，这是一个位于南部艾滋病流行中心的城市。为 第一个目标，我们将与提供者和患者利益相关者合作， 干预措施，并建立在形成性数据的基础上，以完善干预内容，由能力- 能力-动机-行为（COM-B）模型。为了实现第二个目标，我们将在两个 临床设置，并进行混合方法评估，其中连续数据收集由 RE-AIM（覆盖、有效性、采用、实施、维护）框架将用于评估 有效性和实施过程。当这些目标完成后，我们便会收集到丰富的数据 为随后更大规模的CHIMES实施试验提供信息。我们推出重大创新 包括对艾滋病毒/艾滋病综合护理连续体的定性， 在既定实施范围内，YB-GBMSM特有的发展因素（障碍和促进因素） 科学框架。拟议的研究是重要的，因为它有可能为有效的战略提供信息。 改善YB-GBMSM中的HIV病毒抑制和生活质量，从而改善个体和 公共卫生成果符合终止艾滋病毒流行倡议的目标。

PROJECT SUMMARY Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV, with suboptimal rates of engagement across the HIV Continuum of Care (HIV-CoC). Mental health (MH) comorbidities contribute to poor HIV care engagement for many YB-GBMSM; however, effective treatment for these conditions is hindered by barriers including logistical challenges, medical mistrust, and MH stigma. The Ryan White Care act supports integration of HIV and MH services; however, our preliminary studies demonstrate low rates of MH referrals and MH care engagement among YB-GBMSM living with HIV, even in these ostensibly integrated care settings. To our knowledge, there are no published interventions designed specifically to improve MH care engagement among YB-GBMSM living with HIV. The objective of this R34 application is to develop and implement CHIMES (Cross-disciplinary HIV Integrated with Mental Health Support), a clinic- and provider-level intervention to improve HIV-MH care integration and MH care engagement among YB-GBMSM attending Ryan White clinics. The rationale for the project is that efforts to improve integration of services, particularly if they are culturally tailored, are likely to increase MH and HIV care engagement for YB-GBMSM. The proposed study will pursue two specific aims: (1) to develop the CHIMES intervention; and (2) to conduct a hybrid type 2 implementation-effectiveness pilot trial of CHIMES in two HRSA/Ryan White-funded clinics in Atlanta, Georgia – a city in the heart of the Southern HIV epidemic. For the first aim, we will work collaboratively with provider and patient stakeholders, adapt existing evidence-based interventions, and build on formative data to refine intervention content, informed by the Capability- Opportunity-Motivation-Behavior (COM-B) Model. For the second aim, we will implement CHIMES in the two clinic settings and conduct a mixed-methods assessment in which continuous data collection informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework will be used to evaluate effectiveness and implementation processes. Upon completion of these aims, we will have collected rich data to inform a subsequent, larger scale implementation trial of CHIMES. We introduce significant innovations including the characterization of an integrated HIV-MH care continuum and prioritization of cultural and developmental factors (both barriers and facilitators) specific to YB-GBMSM within established implementation science frameworks. The proposed research is significant because of its potential to inform effective strategies for improving HIV viral suppression and quality of life among YB-GBMSM, leading to improved individual and public health outcomes in line with the goals of the Ending the HIV Epidemic initiative.