Development and pilot testing of an intervention to promote care engagement and adherence among HIV-positive Kenyan MSM.
Development and pilot testing of an intervention to promote care engagement and adherence among HIV-positive Kenyan MSM.
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DOI：
10.1097/qad.0000000000000897
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发表时间：
2015-12
期刊：
影响因子：
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通讯作者：
Simoni JM
中科院分区：
文献类型：
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作者：
Graham SM;Micheni M;Kombo B;Van Der Elst EM;Mugo PM;Kivaya E;Aunon F;Kutner B;Sanders EJ;Simoni JM
在许多非洲环境中，男男性行为者是一个被污名化的群体，他们获得和参与艾滋病毒护理可能具有挑战性。我们的目的是设计一个有针对性的，文化上适当的干预措施，以促进护理参与和抗逆转录病毒治疗（ART）坚持在肯尼亚沿海的男男性接触者，并描述干预的安全性，可行性和可接受性的基础上，一个小的试点研究。基于定性工作，包括深入访谈艾滋病毒阳性男男性接触者和焦点小组与供应商，我们制定了一个量身定制的干预措施，并进行了试点测试，以完善干预材料和程序。Shikamana干预结合了经过培训的提供者修改的下一步咨询，经过培训的同伴导航员的支持，以及定制的短信，电话和离散药丸载体的使用。提供者，包括辅导员和临床医生，与同行导航作为一个案例管理团队一起工作。40名19-51岁的艾滋病毒阳性男男性行为者参加了干预措施的制定和测试。六个辅导员，三个临床官员，和四个MSM同行的培训干预程序。在参加试验的10名ART初治参与者中，8名完成了随访，没有报告不良事件。一名参与者在2个月后失访，另一名参与者尽管正在进行咨询，但未能开始ART。未报告不良事件。工作人员的反馈和离职面谈将干预措施评为可行和可接受。这坚持支持干预肯尼亚男男性接触者量身定制的耐受性良好，可行的，在试点阶段可以接受。正在进行一项扩大方案的随机对照试验，以估计干预效果。
In many African settings, MSM are a stigmatized group whose access to and engagement in HIV care may be challenging. Our aim was to design a targeted, culturally appropriate intervention to promote care engagement and antiretroviral therapy (ART) adherence for MSM in coastal Kenya, and describe intervention safety, feasibility, and acceptability based upon a small pilot study. Based on qualitative work including in-depth interviews with HIV-positive MSM and focus groups with providers, we developed a tailored intervention and conducted a pilot test to refine intervention materials and procedures. The Shikamana intervention combines modified Next-Step Counseling by trained providers, support from a trained peer navigator, and tailored use of SMS messaging, phone calls, and discrete pill carriers. Providers, including counselors and clinicians, work together with peer navigators as a case management team. Forty HIV-positive MSM aged 19–51 participated in intervention development and testing. Six counselors, three clinical officers, and four MSM peers were trained in intervention procedures. Of 10 ART-naïve participants who enrolled in the pilot, eight completed follow-up with no adverse events reported. One participant was lost to follow-up after 2 months and another failed to initiate ART despite ongoing counseling. No adverse events were reported. Staff feedback and exit interviews rated the intervention as feasible and acceptable. This adherence support intervention tailored for Kenyan MSM was well tolerated, feasible, and acceptable in the pilot phase. A randomized controlled trial of a scaled-up programme to estimate intervention efficacy is ongoing.