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Principal Investigator: Alida M Bouris
Organization: NORTHWESTERN UNIVERSITY AT CHICAGO
Fiscal Year: 2024
Award: $603,857
Funding agency: National Institute of Mental Health
Project Summary
Among people living with HIV (PLWH), positive affect is uniquely associated with lower levels of depression,
slower disease progression, better adherence to medication, and higher likelihood of achieving suppressed viral
load, independent of negative affect. In two randomized controlled trials with PLWH (R01 MH084723; R01
DA033854), we have shown significant beneficial effects of an intervention that aims to increase positive affect
on viral suppression and psychological well being. We also have demonstrated feasibility, acceptability, and
early efficacy of a self-guided, online-delivered, positive affect skills intervention for PLWH (R34 MH101265).
Now, in collaboration with the AIDS Foundation of Chicago (AFC), we propose to conduct a Hybrid Type II
effectiveness-implementations study of a stepped wedge cluster randomized trial (SW-CRT) of mental health
screening and referral to ORCHID (Optimizing Resilience and Coping with HIV through Internet Delivery). The
proposed study was initiated by AFC, which developed the mental health screening and selected the SW-CRT
design as an ethical way to study implementation while ensuring that all clients with elevated depression receive
the intervention. Mental health screening + ORCHID will be implemented through all medical case managers
(MCMs) at 17 Ryan White-funded clinics in Chicago. We will use the RE-AIM framework to structure the
effectiveness and implementation outcomes and the Consolidated Framework for Implementation Research
(CFIR) to understand the implementation outcomes at the patient and clinic levels. The specific aims are to: (1)
Operationalize an implementation facilitation strategy to link mental health screening with referral to ORCHID
through MCMs at Ryan White-funded clinics in Chicago; (2) Determine the effectiveness of screening + ORCHID
for improving depression, retention in care, and viral suppression, among 300 PLWH receiving care at 17 Ryan
White clinical sites, using a stepped wedge cluster randomized design. Depression is the primary outcome and
retention in care and viral suppression at both the individual and clinic level are the secondary outcomes; and
(3) Evaluate the implementation of screening + ORCHID and iteratively refine the strategy for subsequent steps.
The proposed research holds significant promise for advancing current knowledge on how best to integrate and
respond to mental health screening in Ryan White clinics. Data from the hybrid trial will result in a sustainable,
scalable program that can be disseminated in Ryan White clinics nationwide, thus holding significant promise for
advancing Chicago toward goals in the National Ending the HIV Epidemic Plan.
Terms: <AIDS><AIDS Virus><AIDS test><AIDS/HIV test><Acquired Immune Deficiency><Acquired Immune Deficiency Syndrome><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome><Acquired Immunodeficiency Syndrome Virus><Address><Adherence><Adoption><Affect><Area><Assess implementation><Care Manager><Caring><Case Manager><Characteristics><Chicago><Cities><Client><Clinic><Clinical><Cluster randomization trial><Cluster randomized trial><Collaborations><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Data><Disease Progression><Drug usage><Drugs><Effectiveness><Emotional well being><Ensure><Epidemic><Ethics><Feels well><Focus Groups><Foundations><Funding><General Population><General Public><Goals><HIV><HIV test><HIV-1 test><HIV-2 test><HRSA><Health Resources and Services Administration><Human Immunodeficiency Viruses><Human immunodeficiency virus test><Hybrids><Implementation assessment><Individual><Intervention><Intervention Strategies><Intervention Studies><Knowledge><LAV-HTLV-III><Link><Lymphadenopathy-Associated Virus><Maintenance><Medical><Medication><Mental Depression><Mental Health><Mental Hygiene><Modeling><Normal mental condition><Normal mental state><Normal psyche><Outcome><Participant><Patients><Persons><Pharmaceutical Preparations><Preparation><Process><Psychological Health><Psychological Well Being><RE-AIM><Randomized, Controlled Trials><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Research><Rural><Sampling><Sense of well-being><Site><Structure><Substance abuse problem><Survey Instrument><Surveys><System><United States Health Resources and Services Administration><Viral><Viral Burden><Viral Load><Viral Load result><Virus-HIV><Waiting Lists><Well in self><Work><abuse of substances><assess effectiveness><care outcomes><clinical research site><clinical site><cluster randomized design><co-morbid><co-morbidity><comorbidity><coping><delivered on-line><delivered online><depression><determine effectiveness><drug use><drug/agent><effectiveness analysis><effectiveness and implementation trial><effectiveness assessment><effectiveness evaluation><effectiveness outcome><effectiveness-related outcomes><effectiveness/implementation hybrid study><effectiveness/implementation hybrid trial><effectiveness/implementation study><effectiveness/implementation trial><emotional wellbeing><emotional wellness><epidemic planning><epidemic preparedness><ethical><evaluate effectiveness><evaluate implementation><evaluation of implementation><examine effectiveness><health care outcomes><healthcare outcomes><hybrid type 2 design><hybrid type 2 trial><hybrid type II design><hybrid type II trial><implementation evaluation><implementation facilitation><implementation framework><implementation outcomes><implementation research framework><implementation science framework><implementation strategy><improved><internet based delivery><internet delivered><internet delivery><intervention effect><intervention research><interventional research><interventional strategy><interventional study><interventions research><mental well-being><mental wellbeing><mental wellness><negative affect><negative affectivity><on-line delivery><online delivery><online intervention><pilot test><preparations><primary outcome><programs><psychological wellbeing><psychological wellness><randomized control trial><reach, efficacy, adoption, implementation, and maintenance><resilience><resilient><screening><screenings><secondary outcome><self wellness><sense of wellbeing><sexual minority men><skills><standard of care><strategies for implementation><substance abuse><success><trial design><waitlist><web based delivery>