60 Minutes for health: examining the feasibility and acceptability of a low-resource behavioral intervention designed to promote retention in HIV care.
60 Minutes for health: examining the feasibility and acceptability of a low-resource behavioral intervention designed to promote retention in HIV care.
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DOI：
10.1080/09540121.2017.1344184
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发表时间：
2018-03
期刊：
影响因子：
1.7
通讯作者：
Cunningham CO
中科院分区：
文献类型：
--
作者：
Smith LR;Amico KR;Fisher JD;Cunningham CO
持续保留艾滋病毒医疗护理是艾滋病毒携带者(PLWH)长期健康的关键健康行为。在美国，大约60%的PLWH在HIV护理中保留得很差，但到目前为止，为数不多的基于证据的促进保留干预措施的实施是资源和时间密集型的。目前的研究描述了一种基于理论的促进保留干预的可行性和可接受性，旨在满足繁忙的临床护理环境的需求。60分钟健康反映了一项由健康教育工作者实施的低资源单次干预，针对最近在过去18个月中出现护理缺口(≥6个月)的PLWH。干预内容是通过信息动机行为技能模型的情景应用来告知的，并使用基于动机访谈的形式提供。干预措施使用一本工作簿来指导一系列活动：1)识别和减少指导艾滋病毒护理护理的错误信息。2)通过个人健康目标增强维持护理的动力。3)培养应对与艾滋病毒携带者相关的情绪困扰的技能。4)提高自我效能感，以便在相互竞争的优先事项中驾驭维护护理的后勤。对这一干预方案进行了一项小型可行性试验，以评估其改善护理保留率的潜力，并为更大规模的疗效试验获得估计。参与者被随机分配到60分钟的干预会议(n=8)，或以理论为基础的时间和注意力控制会议，重点是饮食和营养(n=8)。提取医疗记录以评估参与者在干预后12个月和24个月时对护理状态的保留情况的变化。研究结果表明，在临床环境中保留较差的PLWH的情况下，实施干预是可行和可接受的。干预后，与对照组参与者(12个月：50.0%，24个月：25.0%)相比，干预参与者保留在护理中的比例更大(12个月：87.5%，24个月：62.5%)。未来的工作应该着眼于评估更大规模的疗效试验。
Sustained retention in HIV medical care is a key health behavior for the long-term health of people living with HIV (PLWH). Approximately 60% of PLWH in the U.S. are poorly retained in HIV care, yet to date, the few available evidence-based retention-promoting interventions are resource and time intensive to implement. The current study describes the feasibility and acceptability of a theory-based retention-promoting intervention designed to meet the needs of a busy clinical care setting. 60 Minutes for Health reflects a low-resource single-session intervention, implemented by a health educator, to PLWH who have had a recent gap in care (≥6-months) in the past 18-months. Intervention content was informed by a situated application of the Information Motivation Behavioral Skills Model and delivered using a Motivational Interviewing-based format. The intervention uses a workbook to guide a series of activities that: 1) Identify and reduce misinformation guiding HIV care attendance. 2) Enhance motivation to maintain care via personal health goals. 3) Build skills for coping with emotional distress related to living with HIV. 4) Increase self-efficacy for navigating the logistics of maintaining care amidst competing priorities. A small feasibility pilot of this intervention protocol was conducted to assess its potential to improve retention in care and to obtain estimates for a larger-scale efficacy trial. Participants were randomized to the 60-minute intervention session (n=8), or a theory-based time-and-attention control session focused on diet and nutrition (n=8). Medical records were abstracted to evaluate changes in participants’ retention in care status at 12- and 24-months post-intervention. Findings suggest the intervention is both feasible and acceptable to implement with poorly retained PLWH in a clinic setting. Post-intervention a larger proportion of intervention participants were retained in care (12-months: 87.5%, 24-months: 62.5%), compared control participants (12-months: 50.0%, 24-months: 25.0%). Future work should aim to evaluate a larger-scale efficacy trial.
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