Clinic-level implementation of mHealth to improve HIV viral suppression for patients with substance use disorders

项目摘要/摘要 回应PAR-20-036：归零：了解艾滋病病毒的抑制和传播 美国，我们提出了一项混合类型2有效性-实施研究，该研究将评估一项创新的 诊疗级干预，采用循证移动健康(MHealth)应用程序(CHESS)和对等 驱使社会支持。在大型艾滋病毒/艾滋病服务组织的基础设施内，提供综合、 在科罗拉多州、密苏里州、德克萨斯州和威斯康星州，我们将实施以患者为中心的医疗模式 旨在缩小信息差距、建立内在动机和发展所需的行为技能的系统 持续坚持治疗。将通过患者提供的活动提供同伴支持 招募和培训成为同龄人导师。移动健康系统和同行指导将整合到 现有的护理模式，被称为艾滋病毒医疗院。我们假设综合干预将 增加病毒抑制患者的比例，并通过支持减少错过门诊 三个需求：(1)它将促进实时、基于社区的数据捕获，反映社会和行为 已知的导致艾滋病毒护理失误的决定因素(例如，住房和食品不安全、不健康的酒精或 药物使用或服药依从性差)；(2)它将通过增加社会参与来提高护理参与度 患者之间以及患者与同伴导师之间的连通性；以及(3)它将支持在 成瘾治疗和心理健康护理，有助于保持对艾滋病毒护理的参与度。项目第一年将是 致力于规划和完善干预措施，与组织领导人和 艾滋病毒携带者是当地社区的成员。从项目第二年开始，我们将进行 在七个诊所进行的阶梯式楔形整群随机干预试验。我们将利用收集到的数据 通过服务于所有七家诊所的综合电子健康记录系统来测试干预措施 在病毒抑制和保留护理方面的有效性。我们还将进行实施成本分析 以及成本-效果分析，为今后的干预模式的维持提供信息。这项研究建立在一项 之前的研究奠定了坚实的基础，展示了移动健康和同行战略的前景，以增强 参与艾滋病毒和成瘾治疗，并照顾其他复杂的疾病。由此得出的结论是 如果研究成功，将贡献一套新的创新工具，对改进具有很高的潜在影响 在多个地理环境中抑制艾滋病毒病毒。

PROJECT SUMMARY / ABSTRACT In response to PAR-20-036: Getting to Zero: Understanding HIV Viral Suppression and Transmission in the United States, we propose a hybrid type 2 effectiveness-implementation study that will evaluate an innovative clinic-level intervention featuring an evidence-based mobile health (mHealth) application (CHESS) and peer- driven social support. Within the infrastructure of a large HIV/AIDS Service Organization offering an integrated, patient-centered model of care in Colorado, Missouri, Texas and Wisconsin, we will implement an mHealth system designed to close information gaps, build intrinsic motivation, and develop behavioral skills needed for sustained adherence to treatment. Peer support will be provided through activities delivered by patients recruited and trained to serve as peer mentors. The mHealth system and peer mentoring will be integrated into the existing care model, known as the HIV Medical Home. We hypothesize that the integrated intervention will increase the proportion of patients with viral suppression and reduce missed clinic appointments by supporting three needs: (1) It will facilitate real-time, community-based capture of data reflecting social and behavioral determinants known to precede lapses in HIV care (e.g., housing and food insecurity, unhealthy alcohol or drug use, or poor medication adherence); (2) It will improve engagement in care by increasing social connectedness among patients, and between patients and peer mentors; and (3) It will support retention in addiction treatment and mental health care that help maintain engagement in HIV care. Project Year 1 will be devoted to planning and refinement of the intervention in close collaboration with organizational leaders and people living with HIV who are members of the local communities. Beginning in Project Year 2, we will conduct a stepped wedge cluster randomized trial of the intervention in seven clinics. We will leverage data collected through the integrated electronic health record system serving all seven clinics to test intervention effectiveness on viral suppression and retention in care. We also will conduct an implementation cost analysis and cost-effectiveness analysis to inform future sustainment of the intervention model. The study builds on a solid foundation of prior research demonstrating the promise of mHealth and peer strategies for enhancing engagement in HIV and addiction treatment and care for other complex conditions. The findings from this study, if successful, will contribute a new and innovative set of tools with high potential impact for improving HIV viral suppression in multiple geographic settings.