A Multimedia Social Support Intervention: Adherence to HIV Care in South Africa

多媒体社会支持干预：南非坚持艾滋病毒护理

• 批准号: 7500763
• 负责人: ROBERT H REMIEN
• 金额: $ 29.85万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-26 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7500763
• 关键词: Address; Adherence; Adult; African; Alcohol consumption; Anti-Retroviral Agents; Area; Attention; Attitude; Behavior Therapy; Behavioral; Budgets; Caring; Chronic; Clinic; Clinical; Collaborations; Communities; Complex; Computers; Consensus; Counseling; Country; Couples; Data; Development; Disease; Doctor of Philosophy; Drug resistance; Educational Curriculum; Educational process of instructing; Effectiveness; Epidemic; Family member; Friends; Funding; Future; Goals; HIV; HIV Seropositivity; Health; Healthcare; Heterosexuals; Hospitals; Image; Informal Social Control; Information Technology; International; Intervention; Knowledge; Learning; Life; Logistics; Manuals; Medical; Mental Depression; Mental Health; Methodology; Modality; Modeling; Multimedia; NIH Program Announcements; National Institute of Mental Health; New York City; Nurse Practitioners; Nurses; Outcome; Participant; Patients; Personal Satisfaction; Pharmaceutical Preparations; Phase; Physicians; Population; Population Study; Pre-Post Tests; Prevalence; Prevention Research; Prevention education; Principal Investigator; Procedures; Process; Professional counselor; Provider; Psychologist; Public Health; Quality Control; Randomized; Randomized Controlled Trials; Range; Rate; Reporting; Research; Research Methodology; Research Personnel; Resources; Risk; Role; Scientist; Series; Services; Social Network; Social support; Societies; South Africa; Standards of Weights and Measures; Stigmata; Supervision; Techniques; Testing; Time; To specify; Training; Translating; Treatment Protocols; United States; Universities; Victoria Austrailia; Viral Load result; Woman; Work; base; behavioral health; community based participatory research; cost; follow-up; improved; innovation; medication compliance; member; men; men who have sex with men; multidisciplinary; peer; programs; psychosocial; response; scale up; size; social; social stigma; theories; therapy design; tool; transmission process

DESCRIPTION (provided by applicant): HIV is a major threat to the health and psychosocial well-being of infected people, particularly in low-resource countries that have had limited access to antiretroviral treatment (ART). South Africa (SA) has one of the highest HIV prevalence rates in the world. Recently, a national plan was initiated to make ART widely available in SA which will result in a growing population of people living with HIV who survive and must live with HIV disease as a chronic, stigmatizing, and transmittable illness, with the potential for significant public health consequences. The goal of this application is to adapt and pilot test a counselor- and multimedia-driven social support intervention to promote optimal medical care adherence for adult patients accessing ART in SA community based clinics. The original intervention (SMART Couples) was developed and tested in the US with HIV+ adults and their serodiscordant partners. This curriculum will be modified in two primary ways: (1) we will modify the approach so that it can be used with all adult patients on ART, allowing them to include any member of their social network (not just a serodiscordant partner); and (2) we will translate the intervention into a multimedia computer-based format so that it can be used effectively by lay counselors, with minimal training, supervision, and cost. In Phase 1, we will adapt the SMART curriculum for SA adult men and women using a Social Action Theory (SAT) model of behavioral health. We will use community-based participatory research methods (CBPR) to modify the existing curriculum and to specify procedures for intervention and assessment delivery. A series of consumer consultant meetings with health care staff (e.g., nurses, physicians, psychologists, and HIV counselors) and patients accessing HIV services will focus on adapting the intervention for the local setting. Content from the existing SMART manual and newly developed media will be reviewed by theses key stakeholders and the research team. We will examine intervention implementation issues, with attention not only to logistics, but also to attitudes about psychosocial interventions, HIV stigma, and provider roles, particularly those of nurses and adherence counselors. Through the use of CBPR, we will build consensus about which components of the existing SMART intervention are relevant to the SA context and add local techniques that are deemed more relevant, but that also allow us to retain fidelity to core intervention components and our theoretical framework. In Phase 2, 66 HIV+ adult patients at three clinics in the South Peninsula District of the Western Cape (False Bay, Victoria Hospital, and Retreat Clinic) will participate in a pilot randomized controlled trial of the intervention. They will be randomized either to the active intervention or to "standard of care." Participants will be assessed at three time-points (pre- and post-test intervention and 3-month follow-up) on adherence and other behavioral health outcomes, social support processes, and other self-regulation and contextual variables - guided by the SAT model. Process variables, including barriers and facilitators of feasibility and acceptability will be collected from patients and clinic staff. The findings can be used to inform larger-scale effectiveness studies in similar settings.

描述（由申请人提供）：艾滋病毒是对感染者健康和心理健康的主要威胁，特别是在资源匮乏的国家，抗逆转录病毒治疗（ART）的机会有限。南非是世界上艾滋病毒感染率最高的国家之一。最近，启动了一项国家计划，使抗逆转录病毒疗法在南澳大利亚州广泛使用，这将导致越来越多的艾滋病毒感染者幸存下来，并且必须与艾滋病毒疾病一起生活，这是一种慢性、耻辱和可传播的疾病，有可能造成重大的公共卫生后果。该应用程序的目标是适应和试点测试辅导员和多媒体驱动的社会支持干预，以促进最佳的医疗护理坚持成年患者在SA社区为基础的诊所访问ART。最初的干预措施（SMART夫妇）是在美国开发和测试的艾滋病毒+成人和他们的血清不一致的合作伙伴。本课程将在两个主要方面进行修改：（1）我们将修改方法，使其可用于所有接受ART的成人患者，允许他们包括其社交网络的任何成员（不仅仅是血清不一致的伴侣）;以及（2）我们将把干预转化为基于计算机的多媒体格式，以便非专业咨询师可以有效地使用，只需最少的培训，监督，和成本在第一阶段，我们将采用社会行动理论（SAT）行为健康模型为SA成年男性和女性调整SMART课程。我们将使用基于社区的参与式研究方法（CBPR）来修改现有的课程，并指定干预和评估交付程序。与医疗保健人员举行一系列消费者顾问会议（例如，护士、医生、心理学家和艾滋病毒咨询师）和获得艾滋病毒服务的患者将侧重于使干预措施适应当地环境。这些主要利益攸关方和研究小组将审查现有SMART手册和新开发媒体的内容。我们将研究干预措施的实施问题，不仅关注后勤，而且对心理社会干预措施，艾滋病毒的耻辱和提供者的角色，特别是那些护士和依从性顾问的态度。通过使用CBPR，我们将建立共识，现有的SMART干预的组成部分是相关的SA上下文，并添加被认为是更相关的本地技术，但也使我们能够保持保真度的核心干预组件和我们的理论框架。在第二阶段，西开普省南半岛区三家诊所（福尔斯湾、维多利亚医院和康复诊所）的66名艾滋病毒阳性成人患者将参加一项干预措施的试点随机对照试验。他们将被随机分配到积极干预组或标准治疗组。“参与者将在三个时间点（测试干预前后和3个月随访）进行评估，包括依从性和其他行为健康结果，社会支持过程以及其他自我调节和背景变量-由SAT模型指导。将从患者和诊所工作人员处收集过程变量，包括可行性和可接受性的障碍和促进因素。研究结果可用于在类似环境中进行更大规模的有效性研究。