NURSE CASE MANAGERS' HOME-BASED HIV ADHERENCE TRIAL

描述（改编自申请人摘要）：高活性抗逆转录病毒药物 包括蛋白酶抑制剂的HAART疗法已经导致了显著的 减少与艾滋病毒有关的发病率和死亡率。然而， 坚持高效抗逆转录病毒疗法是巨大的。本修订申请提出了一个 随机临床试验，以测试标准化HAART依从性干预 客户依从性分析-干预定制（CAP-IT）计划， 由护士个案管理员在定期安排的家访期间实施， 艾滋病病例管理方案新收治的病人（n=222） 艾滋病，加州。CAP-IT是一个创新的，结构化的护理 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 与现行规范的护理个案管理有显著差异 实践本研究的目的是：1）测试标准化依从性 与标准治疗相比，干预方案可改善HAART 坚持率; 2）为了测试标准化的坚持干预计划， 与标准治疗相比，影响CD 4计数、病毒载量和HAART耐药性; 3)为了测试依从性和CD 4计数之间是否存在关系，病毒 负荷和HAART抵抗; 4）测试标准化依从性干预是否 与标准护理相比，计划影响客户的生活质量;以及，5） 测试标准化依从性干预计划与标准 保健，影响与保健有关的资源利用。文献综述 支持坚持HAART治疗的重要性， 需要进一步研究干预措施的有效性， 改善依从性和随后的健康相关结果。证据也 提供支持的可行性，利用护士个案经理， 提供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.