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

摘要：加强干预以改善HIV+成人的病毒控制和减少合并症事件

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.