HIV+ Service delivery 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: A Protocol for an Effectiveness-Implementation Study (Preprint)

BACKGROUND The syndemic of mental health (MH) and substance use disorders (SUDs) are common among persons living with HIV (PLWH) and jeopardize HIV treatment adherence, engagement in care, and viral load suppression. Electronic patient reported outcomes (ePROs), conducted via 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 PLWH. To date, there has been no guidance on how to implement ePROs and telemedicine into practice even though it is well-known that these evidence-based tools improve diagnosis and access to care. OBJECTIVE To address this, we are conducting a multicomponent intervention for PLWH, 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 The Aims of this intervention are to: Aim 1) Conduct a needs assessment and implement +STEP to improve diagnosis and treatment of mental health (MH) and SUD at RWHAP clinics in Alabama; Aim 2) Describe implementation strategies that address barriers to 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 stakeholders (clinicians, staff) to evaluate barriers, facilitators, and implementation strategies. Results will enable us to modify strategies to enhance +STEP penetrance over time and inform the implementation blueprint, which we will develop for both RWHAP clinics in AL and future sites; Aim 3) Measure the impact of implementing +STEP on diagnoses, referrals, and healthcare utilization related to MH, SUD, and HIV by comparing clinical outcomes from patients receiving these interventions (ePROs, telemedicine) with historical controls. RESULTS 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/or 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 PLWH. Scaling these services represents a path towards 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). Our study will address this evidence gap through the evaluation of implementation of +STEP to establish necessary systems and processes to screen, identify, and better treat substance use and mental health for people living with HIV.