Enhanced Intervention to Improve HIV Viral Control and Reduce Comorbid Events in HIV+ Adults

摘要：加强干预以改善HIV病毒控制，减少HIV+成人的共病事件 改善病毒载量控制的干预措施对于减少迈阿密-戴德的发病率、死亡率和传播至关重要 该县是我国HIV感染率最高的县。超过27,000名艾滋病毒携带者 居住在迈阿密-戴德县，他们中的大多数生活在贫困线以下，获得医疗保健和 治疗。只有不到29%的人口保持着无法检测到的艾滋病毒病毒载量。这一人群也面临着患上 抗逆转录病毒药物的不良影响、生活方式(药物滥用、肥胖和衰老)和其他 糖尿病前期、高胆固醇血症和营养缺乏等情况。这项拟议的研究是一项随机研究 比较有效性研究(CER)试验，比较由 几个学科的专业人员，包括心理学、社会工作和营养学。这种护理模式将整合 根据参与者的标准进行激励性访谈、频繁发送消息、病例管理和营养咨询 医疗护理，并将结果与只接受标准护理的人进行比较。在这项研究中，340名艾滋病毒- 病毒载量不受控制(&gt；50拷贝/毫升)的抗逆转录病毒治疗阳性参与者将被随机分为两组 强化干预组170人，标准干预组170人。参与者将被跟踪 纵向为18个月。拟议的综合干预需要相对较低的投资才能达到较高的 影响结果。激励性访谈、病例管理和频繁的消息传递使患者与 他们的医疗保健和社区服务计划，促进疾病的自我管理，并教育患者 坚持医疗和营养治疗，这对防止病毒载量和生活方式失控至关重要 合并症。包括营养在内的综合干预措施可能会放大和延长心理疾病的影响 病毒控制的策略，也可能有助于管理治疗的副作用，如血脂异常和 高血糖，预防和管理冠心病--非艾滋病毒相关的最常见原因之一 死亡--作为结果，提高了生活质量。我们假设艾滋病毒携带者(PLWH)是 随机纳入增强的综合干预将显示艾滋病毒病毒载量控制率显著提高， 出现较少的高脂血症、糖尿病前期水平的高血糖事件，并改善生活质量评分， 与对照组比较，将PLWH随机分为常规护理/标准护理。成功的干预措施以改善 需要控制在卫生保健方面存在差距的少数群体中的艾滋病毒病毒载量。在这项提案中，我们是 使用创新的管理方法，其中包括激励干预、信息传递和营养 采取干预措施，改善艾滋病毒病毒载量控制，降低发病率和死亡率，以减轻老年人的负担 医疗保健系统。

ABSTRACT: Enhanced Intervention to Improve HIV Viral Control and Reduce Comorbid Events in HIV+ Adults Interventions that improve viral load control are critical to reduce morbidity, mortality and transmission in Miami-Dade County, which has the highest incidence rate of the HIV infection in our nation. More than 27,000 people living with HIV are residing in Miami-Dade County, the majority of them living below poverty level with poor access to healthcare and treatment. Less than 29% of this population maintains an undetectable HIV viral load. This population is also at a risk for adverse effects of the antiretroviral medication, lifestyle conditions (substance abuse, obesity and aging) and other conditions such as prediabetes, hypercholesterolemia and nutritional deficiencies. This proposed study is a randomized comparative effectiveness research (CER) trial that compares an enhanced integrated intervention conducted by professionals in several disciplines, including psychology, social work and nutrition. This model of care will integrate motivational interviewing, frequent messaging, case managing and nutrition counseling with the participant’s standard medical care, and will compare the outcomes with those receiving the standard care alone. For this study, 340 HIV- positive participants on antiretroviral therapy with uncontrolled viral load (>50 copies/mL) will be randomized into two groups, 170 into the enhanced intervention and 170 in the standard intervention. Participants will be followed longitudinally for 18 months. The proposed integrated intervention requires a relatively low investment to achieve high impact outcomes. Motivational interviewing, case managing and frequent messaging keep the patients connected with their healthcare and community-service programs, promoting self-management of the disease, and teaching patients about adhering to their medical and nutritional treatment, which is crucial for preventing uncontrolled viral load and lifestyle comorbidities. Integrated interventions that include nutrition may magnify and prolong the effect of the psychological strategies on viral control, and also may help to manage side-effects of the treatment such as lipid abnormalities and hyperglycemia, preventing and managing coronary heart disease—one of the most frequent causes of non-HIV related deaths—and, as an outcome, improve quality of life. We hypothesized that people living with HIV (PLWH) who are randomized into an enhanced integrated intervention will show significantly improved rates of HIV viral load control, present less events of hyperlipidemias, hyperglycemia at the level of prediabetes, and improved scores of quality of life, compared with a control group of PLWH randomized into the usual/standard care. Successful interventions to improve control of HIV viral load among minority populations with disparities in health care are needed. In this proposal we are using an innovative management approach, which includes motivational intervention, messaging and nutrition intervention to improve HIV viral load control and reduce morbidity and mortality in order to decrease the burden on the healthcare systems.