Culturally Sensitive Intervention to Improve Retention in HIV Care for Latino MSM

描述（由申请人提供）：早期接受和坚持抗逆转录病毒治疗是有效治疗艾滋病毒的关键。但必要的第一步是参与和保留艾滋病毒护理。艾滋病毒+拉丁美洲人迫切需要干预措施，以改善他们在艾滋病毒护理，这可能会受到一些特定的文化因素的影响保留。该提案的目标是在文化上适应和调整现有的基于理论的干预措施，使用最先进的方法，旨在最大限度地提高文化敏感性，可行性和对HIV+拉丁美洲人的可接受性，并在小型随机对照试验中对其进行测试（n=30干预; n=30对照）。这项研究将在HIV阳性的拉丁裔中进行，这些人在前一年至少安排了一次在AltaMed的就诊，AltaMed是洛杉矶最大的拉丁裔HIV医疗服务提供者。拟议的干预措施的目的是保留参与者在艾滋病毒护理解决的障碍和艾滋病毒护理的促进者突出的拉丁美洲人，使用基于组以及一对一，以同伴为基础的学习方法。该提案有三个主要的具体目标：1。进行一项小型的形成性定性研究，以告知旨在改善艾滋病毒+拉丁美洲人艾滋病毒护理保留的干预措施的适应和调整; 2.利用干预措施的定性投入，以适应和定制艾滋病毒+拉丁美洲人，并进行干预措施的小规模预测试，以进一步提高其可行性，可接受性和文化敏感性。3.对干预措施进行预试验，以完善适应性干预方案、评估方案和随机化程序，并评估干预措施的可行性和可接受性。 其次，我们的目标是评估干预措施对HIV护理保留、自我报告依从性和临床结局（包括HIV RNA病毒载量和健康相关生活质量）的初步影响。此外，我们将研究干预措施所针对的变量之间的艾滋病毒护理保留的相关性（例如，艾滋病毒保留知识，结果预期和自我效能），和其他潜在的介质（例如，感知的耻辱、物质使用和其他心理社会变量以及背景特征）。 如果干预被证明是可行的、可接受的和有效的，则结果将用于准备R-01提案，以进行完全把握度的随机干预。最终，这种干预措施可能会对美国各地向艾滋病毒阳性拉丁美洲人提供的医疗保健产生重大而广泛的影响，因为大量艾滋病毒阳性拉丁美洲人接受护理。该提案旨在超越坚持研究的传统重点，服用药物，以解决影响治疗坚持的第一个必要步骤的更广泛的文化和社会因素：保留艾滋病毒护理。 公共卫生相关性：该提案制定了一项文化敏感的干预措施，旨在增加艾滋病毒阳性拉丁美洲人在常规艾滋病毒护理中的保留率。最终，这种干预措施可能会对美国各地向艾滋病毒阳性拉丁美洲人提供的医疗保健产生重大而广泛的影响，因为大量艾滋病毒阳性拉丁美洲人接受护理。该提案旨在超越坚持研究的传统重点，服用药物，以解决影响治疗坚持的第一个必要步骤的更广泛的文化和社会因素：保留艾滋病毒护理。

DESCRIPTION (provided by applicant): Early receipt of and adherence to antiretroviral therapy are critical for effective treatment of HIV. But a necessary first step is engagement with and retention in HIV care. HIV+ Latinos urgently need interventions to improve their retention in HIV care, which may be affected by a number of culture-specific factors. The goal of this proposal is to culturally adapt and tailor an existing, theory-based intervention, using state-of-the-art methods designed to maximize cultural sensitivity, feasibility and acceptability to HIV+ Latinos, and to test it in a small randomized controlled trial (n=30 intervention; n=30 control). The study will be conducted among HIV+ Latinos who have scheduled at least one visit in the prior year at AltaMed, the largest provider of HIV medical services for Latinos in Los Angeles. The proposed intervention is designed to retain participants in HIV care by addressing barriers to and facilitators of HIV care salient to Latinos, using group-based as well as one-on-one, peer-based learning approaches. The proposal has three Primary Specific Aims: 1. To conduct a small formative qualitative research study to inform the adaptation and tailoring of an intervention designed to improve retention in HIV care for HIV+ Latinos; 2. To utilize the qualitative input on the intervention to adapt and tailor it for HIV+ Latinos, and to conduct a small pre-test of the intervention to further improve its feasibility, acceptability, and cultural sensitivity. 3. To pilot test the intervention to refine the adapted intervention protocol, the assessment protocol, and the randomization procedures, and to evaluate the intervention's feasibility and acceptability. Secondarily, we aim to assess the preliminary effects of the intervention on retention in HIV care, self- reported adherence, and clinical outcomes, including HIV RNA viral load and health-related quality of life. In addition, we will examine correlates of retention in HIV care among variables targeted by the intervention (e.g., HIV retention knowledge, outcome expectations, and self-efficacy), and other potential mediators (e.g., perceived stigma, substance use and other psychosocial variables, and background characteristics). If the intervention is shown to be feasible, acceptable, and efficacious, then the results will be used to prepare an R-01 proposal to conduct a fully-powered, randomized intervention. Ultimately, this intervention could have substantial, widespread impact on the health care delivered to HIV+ Latinos across sites in the US where large numbers of HIV+ Latinos receive care. This proposal seeks to move beyond the traditional focus of adherence research, taking medications, to address broader cultural and social factors that affect the first necessary step in treatment adherence: retention in HIV care. PUBLIC HEALTH RELEVANCE: This proposal develops a culturally sensitive intervention aimed at increasing HIV+ Latinos' retention in regular HIV care. Ultimately, this intervention could have substantial, widespread impact on the health care delivered to HIV+ Latinos across sites in the US where large numbers of HIV+ Latinos receive care. This proposal seeks to move beyond the traditional focus of adherence research, taking medications, to address broader cultural and social factors that affect the first necessary step in treatment adherence: retention in HIV care.