实施以证据为基础的艾滋病毒和行为健康综合护理的障碍和促进因素:来自七个联邦结束艾滋病毒流行辖区的观点。

IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv Pub Date : 2024-11-01 Epub Date: 2024-05-21 DOI:10.1080/09540121.2024.2354897
Karen McKinnon, Cody Lentz, Daria Boccher-Lattimore, Francine Cournos, Ariana Pather, Stephen Sukumaran, Adam Thompson, Lori DeLorenzo, Michael Hager, Robert H Remien, Claude A Mellins
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引用次数: 0

摘要

联邦 "结束艾滋病毒流行"(EHE)倡议旨在减少美国艾滋病毒新感染病例,主要是通过接触前预防和艾滋病毒治疗,将艾滋病毒传播率降至零。行为健康疾病(心理健康和药物使用)仍然是实现 EHE 目标的重大障碍。在艾滋病初级医疗机构中解决行为健康(BH)障碍问题已被作为一项重要的 EHE 战略加以推广。实施有效的 HIV-BH 护理整合及其对 HIV 相关健康结果的影响并没有得到很好的记录。在一项由联邦政府资助、处于探索阶段的实施科学研究中,我们使用了集体影响框架(Collective Impact Framework),让七个 EHE 管辖区内的合作伙伴参与讨论在当地 HIV 机构内实施 HIV-BH 整合干预措施的可行性、可接受性和可持续性。合作伙伴的结论是,除非卫生系统在合作实践、专业培训、适当的卫生技术和系统间沟通方面进行投资,否则全面整合仍将是一种例外。合作伙伴支持小规模的渐进式改进,包括跨诊断方法,以加强每个团队成员在共同事业中的价值感。这项早期阶段的实施科学研究确定了研究和实施方面的差距,这些差距对于消除艾滋病毒流行至关重要。集体影响框架和实施科学都为指导未来实施以证据为基础的 HIV-BH 干预整合带来了希望。
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Barriers and facilitators to implementing evidence-based integrated HIV and behavioral health care: perspectives from seven federal ending the HIV epidemic jurisdictions.

The federal Ending the HIV Epidemic (EHE) initiative was created to reduce new US HIV infections, largely through pre-exposure prophylaxis and HIV treatments that reduce HIV transmissibility to zero. Behavioral health disorders (mental health and substance use) remain significant barriers to achieving EHE goals. Addressing behavioral health (BH) disorders within HIV primary care settings has been promoted as a critical EHE strategy. Implementation of efficacious HIV-BH care integration and its impact on HIV-related health outcomes is not well documented. In a federally-funded, exploratory phase implementation science study, we used the Collective Impact Framework to engage partners in seven EHE jurisdictions about the feasibility, acceptability, and sustainability of implementing HIV-BH integration interventions within local HIV settings. Partners concluded that full integration will remain the exception unless health systems invest in collaborative practice, professional training, appropriate health technology, and inter-system communication. Partners supported smaller incremental improvements including transdiagnostic approaches to reinforce each team member's sense of value in the shared endeavor. This early phase implementation science study identified research and implementation gaps that are critical to fill to end the HIV epidemic. Both the Collective Impact Framework and implementation science show promise for guiding future implementation of evidence-based HIV-BH intervention integration.

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