Project Summary
Background: Effective outcomes for persons living with HIV/AIDS depend upon strict adherence to antiretroviral therapy. HIV-positive young men who have sex with men (YMSM) may have a history of childhood abuse or other predisposing factors, such as age and emerging homosexual identity. Emerging sexual identity predisposes young men to less engagement in care and limited ability to adhere with chronic HIV management. Support groups and outreach workers have been partially effective in addressing this issue, but little attention has been paid to educational strategies for the health delivery team related to changing their approach to care management for these patients.
Objectives: Using translational methods, combined with implementation science, our key objectives are to:
- refine, deliver, and determine the acceptability and applicability of an interdisciplinary professional education program that will prepare a site-based multidisciplinary health care team to deliver patient-centered care integrated with ongoing outpatient HIV care;
- document critical mechanisms for integration of care and support when patients have multidimensional needs beyond the scope of routine outpatient care delivery;
- demonstrate impact on patient outcomes (e.g., mental health, quality of life [QOL]), retention in care, and adherence to treatment (e.g., achievement of viral suppression) of early integration of multidimensional care strategies for vulnerable populations with HIV not easily engaged in care; and
- detail use of self-care strategies for staff during integration of new care strategies and explore their impact upon patient-centered outcomes.
Methods: Care and Support Access (CASA), the intervention delivered, uses an iterative teaching method followed by onsite mentored training of site-specific CASA teams, including a patient representative (PR), to introduce palliative approaches into outpatient HIV care. This study will offer team training incorporating PRs during the full process and documenting key techniques that can be translated for use with any difficult-to-engage population. Using an interdisciplinary team approach steered by needs of the patient, PRs on the team will advise on approaches, services, and outcomes. Individualized care is time-consuming and undervalued in current health delivery, yet patients with competing lifestyles and comorbidities require additional assistance. CASA is expected to improve patient outcomes in vulnerable populations by facilitating patient-centered care and enhancing retention in care and adherence to complex treatment to impact QOL, mental health, and survival (e.g., achievement of viral suppression). CASA will be delivered at two clinics; 204 YMSM with HIV/AIDS will be enrolled and followed longitudinally. Patients and clinic staff will complete surveys and qualitative interviews. The project will inform policy and care related to the patient-centered benefits of implementing multidimensional care strategies for populations difficult to engage and retain in care.
Alexander CS, Pappas G, Amoroso A, Lee MC, Brown-Henley Y, Memiah P, O'Neill JF, Dix O, Redfield RR; Members of the AIDSRelief Consortium of PEPFAR. Implementation of HIV Palliative Care: Interprofessional Education to Improve Patient Outcomes in Resource-Constrained Settings, 2004-2012. J Pain Symptom Manage. 2015 Sep;50(3):350-61. doi: 10.1016/j.jpainsymman.2015.03.021. Epub 2015 Jul 16. PubMed PMID: 26188088. (Abstract only available)
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