CASA: Care and Support Access in HIV Disease
Condition: HIV/AIDS
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      This is an investigator-initiated study to measure the impact of an educational intervention
      on the basic palliative approach for a multidisciplinary staff team at an outpatient HIV
      clinic. The study aims to: 1) refine a curriculum for non-palliative care clinicians caring
      for persons living with HIV disease early in the disease trajectory; 2) assess the impact of
      the palliative approach educational intervention on outcomes for 2 target populations: a)
      patients (mental health, quality of life, health-related quality of life and secondarily,
      retention in care and viral suppression) and b) staff (burn-out and caregiving stress). It is
      hypothesized that training outpatient HIV staff in palliative care competencies will improve
      care provided that might, in turn, improve clinical outcomes for HIV patients receiving care
      at that clinic. Quantitative data will be augmented by qualitative interviews of selected
      staff and patients at both clinics in the final year of the study to appreciate response to
      the intervention.
    

Detailed description: 
      Evidence exists in African populations that palliative care delivered early in the HIV
      disease trajectory can improve symptom management and mental health. This study represents a
      proof of principle for HIV care delivery in the US using observed distillation of critical
      palliative elements.

      Care and Support Access (CASA) is a complex multidisciplinary care strategy in which a
      palliative approach is integrated into the delivery of standard HIV care, using an iterative
      teaching method and on-site mentored training of site-based care teams. CASA will implement
      patient-centeredness into HIV treatment at the practice setting to improve patient-level
      outcomes for persons with HIV/AIDS known to have difficulty in engaging in care, initiating
      antiretroviral therapy (ART), and remaining in routine follow-up. This lack of retention puts
      them at high risk for experiencing health-related symptoms and poor quality of life (QOL).

      The study design is quasi-experimental with longitudinal observation of the HIV positive
      young men who have sex with men (yMSM) population and staff who deliver their care at two HIV
      outpatient clinics. We use mixed methods (surveys and qualitative interviews) with the
      patients and staff at both clinics.

      The Specific Aims are:

      (1) To refine, deliver and determine the acceptability and applicability of an
      interdisciplinary professional education program for a site-based multidisciplinary health
      care team on the integration of basic palliative care domains fundamental to patient-centered
      care with standard HIV care.

      2) To obtain insights regarding the CASA experience and to describe and measure the impact of
      early integration of a palliative approach upon yMSM relative to: a) improvement of mental
      health status, health-related quality of life and overall quality of life; b) increased
      retention in care and viral suppression.

      3) To describe and measure the impact upon staff of the early integration of the palliative
      approach with regard to: a) reducing work-related stress; and b) burn-out.

      The anticipated impact of the CASA study will be to improve clinical practice with regard to
      engagement and retention of difficult to engage and retain patient populations by introducing
      a basic palliative approach to care management.
    

Intervention name(s): CASA Education
Intervention type(s): Other
Intervention description(s): Basic palliative care competencies for outpatient use.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Health Services Research
Keywords: HIV disease; palliative care; educational intervention