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

加强干预以改善艾滋病毒病毒控制并减少艾滋病毒成人的合并症事件

• 批准号: 10194597
• 负责人: Adriana Maria Campa
• 金额: $ 5.14万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10194597
• 关键词: Adherence; Adult; Adverse effects; Advocate; Affect; African American; Aging; Alzheimer' s disease risk; Anti-Retroviral Agents; Budgets; Caring; Case Management; Cessation of life; Chronic; Cities; Clinical; Code; Cognition; Color; Communities; Community Services; Comparative Effectiveness Research; Control Groups; Coronary heart disease; Counseling; County; Diabetes Mellitus; Dietary Intervention; Discipline; Discrimination; Disease; Disease Management; Disease Progression; Dyslipidemias; Educational process of instructing; Epidemic; Ethnic Origin; Event; Failure; Florida; Food Safety; Freedom; Funding; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health Care Visit; Healthcare; Healthcare Systems; Hispanics; Hospitalization; Hyperglycemia; Hyperlipidemia; Immune; Incidence; Intervention; Interview; Investments; Latino; Life Style; Lipids; Literature; Malnutrition; Medical; Minority; Modeling; Morbidity - disease rate; Not Hispanic or Latino; Nutritional; Nutritional status; Nutritionist; Obesity; Outcome; Participant; Patients; Pharmaceutical Preparations; Population; Poverty; Poverty Areas; Prediabetes syndrome; Prevalence; Prevention; Process; Psyche structure; Psychology; Quality of life; Randomized; Research; Risk; Self Management; Services; Sleep; Social Work; Substance abuse problem; System; Time; Treatment Cost; Treatment Side Effects; Underserved Population; Viral; Viral Load result; Visit; Waste Management; antiretroviral therapy; community clinic; comorbidity; comparative effectiveness; effective intervention; evidence base; follow-up; food security; health care availability; health care service; health disparity; high risk; hypercholesterolemia; improved; innovation; middle age; mortality; motivational enhancement therapy; motivational intervention; nutrition; nutrition education; obesity management; patient population; prevent; programs; psychologic; service programs; social stigma; standard care; successful intervention; transmission process; trial comparing

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.

摘要：加强干预，改善艾滋病毒控制，减少艾滋病毒阳性成人的共病事件 改善病毒载量控制的干预措施对降低迈阿密-戴德的发病率、死亡率和传播至关重要 该县是我国艾滋病病毒感染发病率最高的县。超过27，000人感染艾滋病毒 居住在迈阿密戴德县，他们中的大多数人生活在贫困线以下，难以获得医疗保健， 治疗不到29%的人保持着不可检测的HIV病毒载量。这一人群也面临着 抗逆转录病毒药物的副作用、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病症。这项拟议的研究是一项随机 比较有效性研究（CER）试验，比较了由以下人员进行的强化综合干预 在心理学、社会工作和营养学等多个学科的专业人员。这种护理模式将整合 动机访谈，频繁的信息传递，案例管理和营养咨询与参与者的标准 医疗护理，并将结果与那些接受标准治疗的人进行比较。在这项研究中，340名艾滋病毒- 将接受抗逆转录病毒治疗且病毒载量不受控制（>50拷贝/mL）的阳性受试者随机分为两组， 170例为强化干预组，170例为标准干预组。参与者将被跟踪 纵向18个月。拟议的综合干预需要相对较低的投资，以实现高 影响结果。动机性访谈、病例管理和频繁的信息传递使患者与 他们的医疗保健和社区服务计划，促进疾病的自我管理，并教导患者 坚持他们的医疗和营养治疗，这对于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， 病毒控制策略，也可能有助于管理治疗的副作用，如血脂异常， 高血糖，预防和管理冠心病-非艾滋病毒相关的最常见的原因之一， 死亡，并作为一个结果，提高生活质量。我们假设，艾滋病毒感染者（PLWH） 随机进入强化综合干预将显示出显著提高的HIV病毒载量控制率， 糖尿病前期水平的高血糖、高血糖事件较少，生活质量评分改善， 与随机接受常规/标准治疗的PLWH对照组相比。成功的干预措施， 需要在卫生保健不平等的少数群体中控制艾滋病毒载量。在本提案中， 采用创新的管理方法，其中包括动机干预、信息传递和营养 采取干预措施，改善艾滋病毒载量控制，降低发病率和死亡率， 医疗保健系统。