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

描述(由申请人提供)：艾滋病毒是对感染者健康和心理社会福祉的重大威胁，特别是在获得抗逆转录病毒治疗(ART)机会有限的低资源国家。南非是世界上艾滋病毒感染率最高的国家之一。最近，启动了一项在南澳广泛提供抗逆转录病毒治疗的国家计划，这将导致越来越多的艾滋病毒携带者存活下来，他们必须与艾滋病毒疾病一起生活，这是一种慢性、耻辱性和传染性疾病，有可能对公共卫生造成重大影响。该应用程序的目标是调整和试点测试一种由顾问和多媒体驱动的社会支持干预，以促进在SA社区诊所接受ART的成年患者的最佳医疗依从性。最初的干预措施(聪明夫妇)是在美国开发并测试的，对象是HIV+的成年人及其血清不一致的伴侣。该课程将以两种主要方式修改：(1)我们将修改方法，使其可以用于所有接受抗逆转录病毒治疗的成年患者，允许他们包括其社交网络中的任何成员(而不仅仅是血清不一致的伴侣)；(2)我们将把干预转化为基于多媒体计算机的格式，以便非专业咨询师可以有效地使用它，而只需最少的培训、监督和成本。在第一阶段，我们将使用行为健康的社会行动理论(SAT)模型为SA成年男性和女性调整SMART课程。我们将使用以社区为基础的参与性研究方法(CBPR)来修改现有课程，并具体说明干预和评估交付的程序。与卫生保健人员(例如护士、医生、心理学家和艾滋病毒顾问)和使用艾滋病毒服务的患者举行的一系列消费者顾问会议将侧重于使干预措施适应当地环境。现有的智能手册和新开发的媒体的内容将由这些主要利益攸关方和研究团队审查。我们将检查干预实施问题，不仅关注后勤，还关注对心理社会干预、艾滋病毒污名和提供者角色的态度，特别是护士和依从性顾问的态度。通过使用CBPR，我们将就现有智能干预的哪些组件与SA环境相关达成共识，并添加被认为更相关的本地技术，但这些技术也允许我们保持对核心干预组件和我们的理论框架的忠诚度。在第二阶段，西开普省南半岛区三家诊所(福斯湾、维多利亚医院和务虚会诊所)的66名HIV+成年患者将参加干预措施的试点随机对照试验。他们将被随机分为积极干预组或“标准护理组”。在SAT模型的指导下，参与者将在三个时间点(测试前和测试后干预以及3个月的跟踪)对遵从性和其他行为健康结果、社会支持过程和其他自我调节和背景变量进行评估。过程变量，包括可行性和可接受性的障碍和促进者，将从患者和诊所工作人员那里收集。这一发现可用于在类似环境下进行更大规模的有效性研究。

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.