Technology Based Community Health Nursing to Improve cART Adherence and Virologic Suppression in Youth Living with HIV (TechN 2 CheckIN): A Regional Multi-site Study

人类免疫缺陷病毒（艾滋病毒）感染一直不成比例地成为公共卫生威胁， 青少年和年轻的成年人（AYA）从少数民族社区在美国。艾滋病毒已经演变成一种 慢性病，可以在门诊接受抗逆转录病毒治疗（ART）， 实现病毒学抑制和未感染个体的预期寿命。然而，对于AYA来说， 与成年人相比，存在着巨大的差距，更多的人不知道自己的地位， 参与，保留，启动和维持ART，导致病毒学非感染性疾病的发生率更高。 抑制和后遗症的发展，包括免疫恶化和传播。 旨在改善感染艾滋病毒的青年的成果的干预措施正在由以下机构赞助： 包括疾病控制和预防中心和国立卫生研究院在内的机构， 然而，大多数针对的是连续护理的早期组成部分（识别、联系和ART 启动）。我们来自HIV研究网络的研究表明，30-40%的YLHIV不是病毒学上的。 尽管在护理中，但仍受到抑制，突出了针对远端组件的新型干预措施的需求 关怀的连续性。社区卫生护士（CHN）干预措施已被证明可以增加获得 适当的资源，提高卫生保健利用率，并促进AYA之间的风险降低行为。使用 短消息服务（SMS）消息可以通过提高出勤率来进一步加强临床护理， 医疗访问、药物依从性以及与医疗保健团队的沟通。我们用这两个 在低收入地区患有复杂性传播感染（STI）的青年中进行随机试验的模式 少数族裔社区在AYA及其家人中具有很高的可行性和可接受性，值得注意 改善访视完成率、药物依从性和减少复发性病。总体 该项目的目标是建立在该试验的证据基础上，并重新调整YLHIV干预的目的， 同一个社区，他们面临着护理和药物不依从性的挑战。我们的目标是比较 技术增强型社区健康护理干预（THA-N2 THAK-IN）对 标准治疗对照组采用随机试验设计。核心假设是， 将导致更高的ART依从率和病毒学抑制。我们已经证明了我们的 跨学科团队在社区中跟踪城市AYA的能力，利用CHN和 外展工作者根据国家标准优化护理。E-IN 2 E-IN的目标是招收120名 在巴尔的摩-华盛顿大都会地区专门从事艾滋病毒护理的诊所， 挑战治疗依从性，并将其随机分配至接受治疗2和标准治疗 在乎这项试验的结果将通过解决YLHIV的远端部分，为参与YLHIV的最佳实践提供信息。 这一连续体对于实现难以捉摸的90-90-90艾滋病毒目标至关重要。

Human immunodeficiency virus (HIV) infection has disproportionately persisted as a public health threat to adolescents and young adults (AYA) from minority communities in the United States. HIV has evolved into a chronic disease, which can be managed in the outpatient setting with antiretroviral therapy (ART) designed to achieve virologic suppression and life expectancy equivalent for uninfected individuals. However, for AYA, huge disparities exist compared to adults, with greater proportions unaware of their status, lower rates of care engagement, retention, and initiation and maintenance of ART, resulting in higher rates of virologic non- suppression, and development of sequelae including immunologic deterioration and transmission. Interventions designed to improve outcomes for youth living with HIV (YLHIV) are being sponsored by agencies including the Centers for Disease Control and Prevention and the National Institutes of Health, however, most target the early components of the continuum of care (identification, linkage, and ART initiation). Our research from the HIV Research Network shows that 30-40% of YLHIV are not virologically suppressed despite being in care, highlighting the need for novel interventions targeting the distal components of the care continuum. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources, enhance health care utilization, and promote risk-reducing behavior among AYA. Use of short messaging service (SMS) messaging can further enhance clinical care by improving attendance at medical visits, medication adherence, and communication with the health care team. We have used these two modalities in randomized trials of youth with complex sexually transmitted infections (STIs) in low-income minority communities with high feasibility and acceptability amongst AYA and their families, remarkable improvements in visit completion, medication adherence, and reduction in recurrent STIs. The overarching goal of this project is to build on the evidence from this trial and to repurpose the intervention for YLHIV in the same community who are having challenges with care and medication non-adherence. We aim to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N 2 CHECK-IN) to a standard of care control group using a randomized trial design. The central hypothesis is that the intervention will result in higher rates of adherence to ART and virologic suppression. We have demonstrated our interdisciplinary team's capacity to follow urban AYA in the community, utilizing the combination of CHNs and outreach workers to optimize care according to national standards. TECH-IN 2 CHECK-IN aims to enroll 120 YLHIV followed at clinics specializing in HIV care in the Baltimore-Washington Metropolitan area who are challenged with treatment adherence and randomizing them to receive TECH-IN 2 CHECK-IN vs. standard of care. Results of this trial will inform best practices for engaging YLHIV by addressing the distal component of the continuum, critical to achieving the elusive 90-90-90 HIV goals.