NURSE CASE MANAGERS' HOME-BASED HIV ADHERENCE TRIAL

描述(摘自申请者摘要)：高效抗逆转录病毒 包括一种蛋白酶抑制剂的治疗(HAART)导致了显著的 减少与艾滋病毒有关的发病率和死亡率。然而，挑战是 坚持HAART疗法意义重大。这项修订后的申请提出了一个 用于测试标准化HAART依从性干预的随机临床试验 计划、客户遵守情况分析-干预定制(CAP-IT)、 由护士个案经理在定期家访期间执行，以 222名新近进入艾滋病病例管理项目的患者 艾滋病，加利福尼亚州。CAP-IT是一种创新的结构化护理 评估和护理规划活动，允许标准化评估 客户需求和定制的HAART干预策略。CAP-IT是 与现行标准护理病历管理有显著不同 练习一下。这项研究的目的是：1)测试标准化依从性 与标准护理相比，干预计划可以改善HAART 依从率；2)测试标准化的依从性干预计划， 与标准护理相比，影响CD4计数、病毒载量和HAART抵抗力； 3)测试依从性与CD4计数、病毒感染是否有关系 负载和HAART抵抗；4)测试标准化的依从性干预 与标准护理相比，计划会影响患者的生活质量；以及，5) 测试标准化依从性干预计划是否与标准的 保健，影响与健康有关的资源利用。文献综述 支持坚持HAART治疗问题的重要性和 需要对干预措施的有效性进行进一步研究 在改善遵从性和随后与健康相关的结果方面。证据也是 为支持利用护士病例经理的可行性提供支持 分娩是一种基于家庭护理的依从性干预。

DESCRIPTION (Adapted from Applicant's Abstract): Highly active antiretroviral therapy (HAART) that includes a protease inhibitor has led to significant reductions in HIV-related morbidity and mortality. However, the challenge of adhering to HAART therapy is immense. This revised application proposes a randomized clinical trial to test a standardized HAART adherence intervention program, Client Adherence Profiling-Intervention Tailoring (CAP-IT), implemented by nurse case managers during regularly scheduled home visits, for clients (n=222) newly admitted in the AIDS Case Management Program, Office of AIDS, State of California. CAP-IT is an innovative, structured nursing assessment and care planning activity that allows a standardized assessment of client needs and tailored HAART intervention strategies. CAP-IT is significantly different from the current standard nursing case management practice. The study aims are: 1) To test if a standardized adherence intervention program, compared to standard care, results in improved HAART adherence rates; 2) To test if a standardized adherence intervention program, compared to standard care, impacts CD4 count, viral load, and HAART resistance; 3) To test if there is a relationship between adherence and CD4 count, viral load, and HAART resistance; 4) To test if a standardized adherence intervention program, compared to standard care, impacts clients' quality of life; and, 5) To test if a standardized adherence intervention program, compared to standard care, impacts health-related resource utilization. The review of the literature supports the significance of the issue of adherence to HAART therapy and the need for further research focused on the effectiveness of interventions aimed at improving adherence and subsequent health-related outcomes. Evidence is also provided to support the feasibility of utilizing nurse case managers to delivery a home care-based adherence intervention.