REACH(共病 HIV/创伤后应激障碍/物质使用障碍人群的弹性、参与和可及性)方案:使用通用筛查工具改善心理健康并提高 HIV 护理结果。

The REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD/SUD populations) Protocol: Using a Universal Screener to Improve Mental Health and Enhance HIV Care Outcomes.

机构信息

Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.

University of South Carolina, Columbia, SC, USA.

出版信息

J Behav Health Serv Res. 2023 Oct;50(4):452-467. doi: 10.1007/s11414-023-09850-7. Epub 2023 Jul 31.

Abstract

Among people living with HIV (PLWH), 50% report substance use disorders (SUDs), and 30-61% report posttraumatic stress disorder (PTSD). Comorbid PTSD/SUD/HIV has been linked to faster HIV progression and twice the rate of death, lower medical adherence and retention, and increased viral load compared to PLWH without co-occurring PTSD or SUD. A critical first step in establishing comprehensive mental health services for PLWH is the implementation of an evidence-based screening protocol for PTSD and SUDs to facilitate referrals to specialty mental health providers. Guided by the Consolidated Framework for Implementation Research, this mixed-methods study aimed to examine the feasibility of delivering the REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD/SUD populations) Screening protocol. Three case managers were instructed to provide the REACH screening electronically to all patients that they saw for enrollment or re-enrollment appointments over 3 months (n=102). Of the 70 patients who completed the screener, 27% had clinically significant PTSD symptoms and 48.6% had SUD concerns. Qualitative feedback revealed themes related to beliefs about SU and PTSD, attitudes toward screening, comfort in the discussion of SU and PTSD, and referral and treatment considerations. Discussion includes lessons learned for implementation of this assessment of PTSD/SUD in PLWH as a novel approach to increase mental health engagement and promote health equity, with the potential long-term impact of improving HIV care outcomes via ameliorating mental health/SUD, and implications for prevention of HIV transmission. Implementation science can be leveraged to understand the gap in the utilization of existing evidence-based screening tools in HIV care settings.

摘要

在感染艾滋病毒(HIV)的人群中,有 50%报告存在物质使用障碍(SUD),有 30-61%报告患有创伤后应激障碍(PTSD)。合并 PTSD/SUD/HIV 与 HIV 进展更快、死亡率增加一倍、医疗依从性和保留率降低以及病毒载量增加有关,与没有合并 PTSD 或 SUD 的 HIV 感染者相比。为感染艾滋病毒的人建立全面心理健康服务的关键第一步是实施基于证据的 PTSD 和 SUD 筛查方案,以促进向专业心理健康提供者转介。本混合方法研究以实施研究综合框架为指导,旨在检查提供 REACH(合并 HIV/PTSD/SUD 人群的弹性、参与和可及性)筛查方案的可行性。三名个案经理被指示在 3 个月内(n=102),通过电子方式向他们看到的所有参加或重新参加预约的患者提供 REACH 筛查。在完成筛查的 70 名患者中,27%有明显的 PTSD 症状,48.6%有 SUD 问题。定性反馈揭示了与对 SUD 和 PTSD 的信念、对筛查的态度、对 SUD 和 PTSD 讨论的舒适度以及转诊和治疗考虑相关的主题。讨论包括在 HIV 感染者中实施 PTSD/SUD 评估的经验教训,这是一种增加心理健康参与和促进健康公平的新方法,通过改善心理健康/SUD,有可能对改善 HIV 护理结果产生长期影响,并对预防 HIV 传播产生影响。实施科学可以用来了解在 HIV 护理环境中利用现有基于证据的筛查工具方面存在的差距。

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