Stronger Together: Results from a Randomized Controlled Efficacy Trial of a Dyadic Intervention to Improve Engagement in HIV Care Among Serodiscordant Male Couples in Three US Cities.
Stronger Together: Results from a Randomized Controlled Efficacy Trial of a Dyadic Intervention to Improve Engagement in HIV Care Among Serodiscordant Male Couples in Three US Cities.
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DOI：
10.1007/s10461-021-03199-8
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发表时间：
2021-08
影响因子：
4.4
通讯作者：
Mimiaga MJ
中科院分区：
文献类型：
--
作者：
Stephenson R;Garofalo R;Sullivan PS;Hidalgo MA;Bazzi AR;Hoehnle S;Bratcher A;Finneran CA;Mimiaga MJ
艾滋病毒感染者参与艾滋病毒护理和高水平的抗逆转录病毒治疗 (ART) 依从性对于治疗成功至关重要，并且可以最大限度地减少该疾病的人口负担。尽管如此，艾滋病毒预防科学在针对血清不一致的男性夫妇制定干预措施方面仍存在重大差距。本文报告了一项随机对照试验的结果，该试验旨在评估“Stronger Together”的功效，这是一种二元咨询干预措施，旨在提高佐治亚州亚特兰大、马萨诸塞州波士顿和伊利诺伊州芝加哥血清不一致的男性夫妇对艾滋病毒护理的参与度并优化其艾滋病毒护理。 2014 年至 2017 年间，乔治亚州亚特兰大、马萨诸塞州波士顿和伊利诺伊州芝加哥的 159 对血清学不一致的男性夫妇（总共 N = 318）被纳入研究，并同样随机分配到 Stronger Together 干预组（涉及 HIV 检测和依从性咨询的三期二元干预）或标准护理 (SOC) 对照组。夫妇在基线、6、12 和 18 个月时通过音频计算机辅助自我访谈 (ACASI) 系统完成个人研究评估。主要结局包括已处方并目前正在接受 ART，以及过去 30 天内错过的 ART 剂量减少；由于该试验没有能力检查病毒抑制，因此我们将其作为探索性结果进行检查。纵向数据分析采用意向治疗方法。参与者年龄从 18 岁到 69 岁不等（平均 35.9 岁），主要是白人（77.5%），并且受过大学教育（68.4% 获得大学或更高学位）。与 SOC 组相比，随机分配到 Stronger Together 组的参与者随时间推移接受处方治疗和目前正在接受 ART 的几率明显更高（12 个月时 OR 2.75，95%CI 1.35–4.67，p 值 0.020；18 个月时 OR 2.91，95%CI 1.61–4.88，p 值 0.013）。同样，与 SOC 组相比，Stronger Together 组中的患者在过去 30 天内错过一剂 ART 的几率明显较低（12 个月时 OR 0.28，95%CI 0.09–0.81，p 值 0.019；18 个月时 OR 0.25，95%CI 0.07–0.82，p 值） 0.023）。在血清不和谐关系的男性夫妇中，Stronger Together 干预措施在 12 个月和 18 个月的随访中显着改善了 HIV 治疗结果。该试验是迄今为止第一个证明二元咨询干预措施有效的证据，并有可能填补血清不一致男性夫妇艾滋病毒二级预防干预措施的关键空白。
Engagement in HIV care and a high level of antiretroviral therapy (ART) adherence for people living with HIV is crucial to treatment success and can minimize the population burden of the disease. Despite this, there is a critical gap in HIV prevention science around the development of interventions for serodiscordant male couples. This paper reports on the results of a randomized controlled trial to assess the efficacy of Stronger Together, a dyadic counseling intervention aimed at increasing engagement in and optimizing HIV care among serodiscordant male couples in Atlanta, GA, Boston, MA, and Chicago, IL. Between 2014 and 2017, 159 male serodiscordant couples (total N = 318) in Atlanta, GA, Boston, MA, and Chicago, IL were enrolled and equally randomized to either the Stronger Together intervention arm (a three-session dyadic intervention involving HIV testing and adherence counseling) or a standard of care (SOC) control arm. Couples completed individual study assessments via an audio computer assisted self-interviewing (ACASI) system at baseline, 6, 12 and 18 months. Primary outcomes included being prescribed and currently taking ART, and fewer missed doses of ART in the past 30 days; because the trial was not powered to examine viral suppression, we examined this as an exploratory outcome. Longitudinal data analysis was by an intention-to-treat approach. Participants ages ranged from 18 to 69 (mean = 35.9), and are predominantly white (77.5%), and college educated (68.4% earned a college degree or higher). Participants randomized to the Stronger Together arm had a significantly greater odds of being prescribed and currently taking ART over time than those in the SOC arm (at 12 months OR 2.75, 95%CI 1.35–4.67, p-value 0.020, and at 18 months OR 2.91, 95%CI 1.61–4.88, p-value 0.013). Similarly, those in the Stronger Together arm had a significantly lower odds of missing a dose of ART in the past 30 days over time compared to those in the SOC arm (at 12 months OR 0.28, 95%CI 0.09–0.81, p-value 0.019, and at 18 months OR 0.25, 95%CI 0.07–0.82, p-value 0.023). Among male couples in serodiscordant relationships, the Stronger Together intervention resulted in significantly improved HIV treatment outcomes at both 12 and 18 months of follow-up. This trial is the first to date to demonstrate evidence of efficacy for a dyadic counseling intervention and has the potential to fill a critical gap in secondary HIV prevention interventions for serodiscordant male couples.
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影响因子：
1.4
作者：
Crawford, JM;Rodden, P;Van de Ven, P
通讯作者：
Van de Ven, P
影响因子：
3.8
作者：
Hoff, Colleen C.;Beougher, Sean C.
通讯作者：
Beougher, Sean C.
影响因子：
1.7
作者：
Hoff CC;Beougher SC;Chakravarty D;Darbes LA;Neilands TB
通讯作者：
Neilands TB
影响因子：
4.4
作者：
Mitchell, Jason W.
通讯作者：
Mitchell, Jason W.
影响因子：
3.1
作者：
Finitsis, David J.;Pellowski, Jennifer A.;Kalichman, Seth C.
通讯作者：
Kalichman, Seth C.