Delivery of the HIV Service and Telemedicine Through Effective Patient-Reported Outcomes (+STEP) Intervention to Increase Screening and Treatment of Mental Health and Substance Use Disorders for People Living With HIV in Alabama: Protocol for an Effectiveness-Implementation Study.

Autor:	Gagnon KW; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.; Center for Addiction and Pain Prevention and Intervention, University of Alabama at Birmingham, Birmingham, AL, United States., Baral S; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States., Long D; Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.; Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States., Guzman AL; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Johnson B; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Burkholder G; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.; Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Willig J; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.; Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Mugavero M; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.; Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Baldwin M; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Fogger S; Nursing Family, Community and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States., Creger T; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Cropsey K; Center for Addiction and Pain Prevention and Intervention, University of Alabama at Birmingham, Birmingham, AL, United States.; Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States., Eaton E; Division of Infectious Disease, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.; Center for Addiction and Pain Prevention and Intervention, University of Alabama at Birmingham, Birmingham, AL, United States.; Centers for AIDS Research, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.
Jazyk:	angličtina
Zdroj:	JMIR research protocols [JMIR Res Protoc] 2023 Aug 15; Vol. 12, pp. e40470. Date of Electronic Publication: 2023 Aug 15.
DOI:	10.2196/40470
Abstrakt:	Background: The syndemic of mental health (MH) and substance use disorders (SUDs) is common among persons living with HIV and jeopardizes HIV treatment adherence, engagement in care, and viral load suppression. Electronic patient-reported outcomes (ePROs), completed through tablet or computer, and telemedicine are evidence- and technology-based interventions that have been used to successfully increase screening and treatment, respectively, a model that holds promise for persons living with HIV. To date, there is limited guidance on implementing ePROs and telemedicine into HIV clinical practice even though it is well known that these evidence-based tools improve diagnosis and access to care. Objective: To address this, we aim to conduct a multicomponent intervention for persons living with HIV, including the delivery of HIV services and telemedicine through effective ePROs (+STEP), to increase screening and treatment of MH and SUD in Ryan White HIV/AIDS Program (RWHAP)-funded clinics in Alabama. Methods: Through this intervention, we will conduct a readiness, acceptability, and accessibility assessment and implement +STEP to improve the diagnosis and treatment of MH and SUD at RWHAP clinics in Alabama. To describe implementation strategies that address barriers to the uptake of +STEP in RWHAP clinics, we will conduct qualitative interviews in years 1 (early implementation), 2 (scale up), and 4 (maintenance) with patients and key staff to evaluate barriers, facilitators, and implementation strategies. Our Results will enable us to modify strategies to enhance +STEP penetration over time and inform the implementation blueprint, which we will develop for both RWHAP clinics in Alabama and future sites. We will assess the impact of implementing +STEP on diagnoses, referrals, and health care use related to MH, SUD, and HIV by comparing clinical outcomes from patients receiving these interventions (ePROs and telemedicine) with historical controls. Results: The first study site began implementation in April 2022. A total of 2 additional sites have initiated ePROs. Final results are expected in 2026. The results of this study will provide a foundation for future research expanding access to ePROs for improved diagnosis linked to telemedicine access to accelerate patients along the continuum of care from MH and SUD diagnosis to treatment. Conclusions: Achieving the end of the HIV epidemic in the United States necessitates programs that accelerate movement across the MH and SUD care continuum from diagnosis to treatment for persons living with HIV. Scaling these services represents a path toward improved treatment outcomes with both individual health and population-level prevention benefits of sustained HIV viral suppression in the era of undetectable=untransmittable (U=U). This study will address this evidence gap through the evaluation of the implementation of +STEP to establish the necessary systems and processes to screen, identify, and better treat substance use and MH for people living with HIV. International Registered Report Identifier (irrid): DERR1-10.2196/40470. (©Kelly W Gagnon, Stefan Baral, Dustin Long, Alfredo L Guzman, Bernadette Johnson, Greer Burkholder, James Willig, Michael Mugavero, Margaret Baldwin, Susanne Fogger, Thomas Creger, Karen Cropsey, Ellen Eaton. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 15.08.2023.)
Databáze:	MEDLINE
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