Golub Sarit A, Hubbard Stephanie, de Roche Ariel M, Barton Staci C, Merges Angela, Klein Augustus
Hunter Alliance for Research and Translation, Department of Psychology, Hunter College, City University of New York.
Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, New York City Department of Health and Mental Hygiene.
Psychol Serv. 2025 Apr 7. doi: 10.1037/ser0000935.
Progress toward ending the HIV epidemic has been slowed by suboptimal utilization of effective biomedical interventions (e.g., HIV testing, pre-exposure prophylaxis), especially for populations with the highest incidence. In 2021, the New York City Health Department initiated a multilevel implementation strategy, focused on promoting the GOALS Approach to Sexual History and Health-an antistigmatizing, client-centered strategy for sexual history taking-as a lever for increasing HIV intervention adoption, reach, and equity. Project Partnership to Increase Access, Client-Centered Care, and Equity in HIV Services is a community-academic implementation science partnership designed to investigate the impact of strategy enactment on implementation outcomes, including changes in intervention utilization (HIV testing, sexually transmitted infection testing, pre-exposure prophylaxis) in practice over time. This article presents preliminary implementation outcomes collected from the 19 programs (client = 8,865) funded to adopt GOALS. Data indicate the successful enactment of systems-level strategies (infrastructure development, service mandates), program-level strategies (staff training, learning collaboratives), and provider-level strategies (utilization of the GOALS). By Quarter 5, the GOALS was being utilized in a median of 84% of visits across programs (interquartile range: 54%-97%), and GOALS utilization was positively associated with provider adoption of HIV prevention interventions in practice. Programs that struggled with implementation had less buy-in from leadership and lower commitment to provider training; programs with upward implementation trends had less experience delivering sexual health care and used a phased approach to foster support, focusing on the positive reaction to the GOALS among their clients. These data suggest that a multilevel implementation strategy focused on delivery of antistigma, client-centered sexual histories may be a potent implementation strategy for enhancing HIV prevention intervention adoption. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
有效生物医学干预措施（如艾滋病毒检测、暴露前预防）的利用未达最佳水平，这减缓了终结艾滋病毒流行的进程，尤其是在发病率最高的人群中。2021年，纽约市卫生部门启动了一项多层次实施战略，重点推广“性病史与健康目标法”（GOALS Approach to Sexual History and Health）——一种消除污名化、以客户为中心的性病史询问策略——作为提高艾滋病毒干预措施采用率、覆盖面和公平性的手段。“增加艾滋病毒服务可及性、以客户为中心的护理及公平性项目伙伴关系”（Project Partnership to Increase Access, Client-Centered Care, and Equity in HIV Services）是一个社区-学术实施科学伙伴关系，旨在调查战略实施对实施结果的影响，包括随着时间推移，实际干预措施利用情况（艾滋病毒检测、性传播感染检测、暴露前预防）的变化。本文介绍了从19个获得资助采用“目标法”的项目（客户 = 8865）收集到的初步实施结果。数据表明，系统层面的战略（基础设施建设、服务要求）、项目层面的战略（员工培训、学习协作小组）和提供者层面的战略（采用“目标法”）均成功实施。到第5季度，各项目中，平均有84%的就诊使用了“目标法”（四分位距：54%-97%），“目标法”的使用与提供者在实际工作中采用艾滋病毒预防干预措施呈正相关。在实施方面遇到困难的项目，领导层的支持较少，对提供者培训的投入也较低；实施呈上升趋势的项目，提供性健康护理的经验较少，并采用分阶段方法来促进支持，重点关注客户对“目标法”的积极反应。这些数据表明，一项侧重于提供消除污名化、以客户为中心的性病史的多层次实施战略，可能是提高艾滋病毒预防干预措施采用率的有效实施战略。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
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