Intervention to Increase Timely Initiation of HAART Among Those Who Delay/Decline

描述(申请人提供)：这项研究涉及艾滋病毒/艾滋病治疗中的种族/民族差异。在美国，许多艾滋病毒/艾滋病患者(PLHA)(10%-19%)，主要是有色人种，将高效抗逆转录病毒疗法(HAART)的服用推迟到艾滋病毒疾病晚期，或者在医学上有迹象表明时从不开始HAART。与服用HAART的人群相比，这些人群经历了更高的发病率和早期死亡率，更高的医疗费用，并且不太可能实现病毒学抑制(增加将艾滋病毒传播给其他人的可能性)。然而，我们没有行为干预来增加HAART在这一群体中的及时启动和持续使用。这项建议旨在开发一种可持续、灵活和个性化的基于视频的干预措施，以激励和准备个人发起和继续HAART，目标是针对人口所经历的特定障碍。我们将医学上有资格接受HAART但推迟或拒绝HAART的PLHA人群称为“PLHA-DD”。拟议的干预措施是对坚持干预措施的补充，PLHA-DD在启动HAART时可以从中受益。干预措施将量身定做，以解决PLHA-DD面临的HAART的多层次障碍，他们主要是非洲裔美国人和拉丁裔。这些障碍包括个人--(例如，恐惧、不信任、低自我效能、相互竞争的优先事项)、社会--(例如，消极的同伴健康规范、耻辱)和结构层面的影响(例如，准入)。在多层次社会认知理论三元影响力理论和反种族主义立场的指导下，干预期将持续12周，由三个单独的会议(总时间为3.5小时)和患者导航组成，这是一种降低医疗保健系统障碍的低门槛、支持性和适应性方法，其强度将取决于参与者的需求。干预会议将包括有针对性的视频和个性化的互动组件。为了减少社会障碍，干预将包括一个“支持伙伴”。HAART启动的心理、社会和医学方面将密切结合在一起。这个为期三年的项目的目的是：(1)探索提供者和PLHA-DD对启动/继续HAART的障碍的看法；(2)制定干预的组成部分，检查它们的可接受性、安全性和可行性，并收集关于HAART启动/继续的有效性的初步证据。为了实现这些目标，我们建议进行三个阶段的研究：(1)启发式，研究提供者(N=18)和PLHA-DD(N=16)的观点；(2)发展，创建干预组成部分；(3)评估，测试和修订干预组成部分(N=80 PLHA-DD；50%非裔美国人，50%拉美裔/西班牙裔，从两家大型艾滋病毒诊所招募)。这项拟议的研究具有创新性，因为它试图扩大HAART坚持的研究范式，将HAART的启动包括在内。虽然PLHA-DD在人群中所占比例不大，但在PLHA-DD中采取有效的干预措施以减少发病率、延长寿命、降低医疗费用和增加病毒载量抑制具有很高的公共卫生意义。 公共卫生相关性：这项研究涉及艾滋病毒/艾滋病治疗中的种族/民族差异。在美国，许多艾滋病毒/艾滋病(PLHA)患者(占PLHA的10%-19%)，主要是非洲裔美国人和拉美裔美国人，将接受高效抗逆转录病毒疗法(HAART)推迟到他们艾滋病毒病程的晚期，或者在医学上显示HAART时从不开始HAART。然而，在延迟或拒绝HAART(“PLHA-DD”)的PLHA中，没有行为干预来增加HAART的启动。这项拟议研究的总体目标是开发一种灵活、有针对性和可持续的行为干预措施，以增加PLHA-DD中HAART的启动，如果有效，将导致发病率、早期死亡率和医疗成本的降低，以及增加病毒载量抑制(减少对其他人的传播)。此外，这项研究补充了参与者现有的依从性干预措施，当他们启动HAART时，PLHA-DD可以从中受益。

DESCRIPTION (provided by applicant): This study addresses racial/ethnic disparities in HIV/AIDS treatment. Many persons living with HIV/AIDS (PLHA) in the US (10-19%), predominantly people of color, delay taking Highly Active Antiretroviral Therapy (HAART) until late in their HIV disease or never initiate HAART when it is medically indicated. This population experiences higher morbidity and early mortality, higher health care costs, and is less likely to achieve virologic suppression (increasing the probability of HIV transmission to others) compared to those taking HAART. However, we do not have a behavioral intervention to increase the timely initiation and continued use of HAART in this group. This proposal seeks to develop a sustainable, flexible, and individualized video-based intervention to motivate and prepare individuals to initiate and continue HAART, targeted to the specific barriers experienced by the population. We refer to this population of PLHA medically eligible for HAART but who have delayed or declined HAART as "PLHA-DD." The proposed intervention is a complement to adherence interventions, from which PLHA-DD can benefit when they initiate HAART. The intervention will be tailored to address the multi-level barriers to HAART experienced by PLHA-DD, who are predominantly African-American and Latino. These barriers include individual- (e.g., fear, mistrust, low self efficacy, competing priorities), social- (e.g. negative peer health norms, stigma), and structural-level influences (e.g., access). Guided by the Theory of Triadic Influence, a multi-level social-cognitive theory, and the Anti-racist Stance, the intervention period will last 12 weeks and be made up of three individual sessions (3.5 hours total time) and patient navigation, a low-threshold, supportive, and adaptable approach for reducing health care system barriers, the intensity of which will depend on the participant's needs. Intervention sessions will consist of targeted video and individualized interactive components. To reduce social barriers, the intervention will include a "support partner." Psychosocial and medical aspects of HAART initiation will be closely integrated. The aims of this three-year project are to: (1) explore providers' and PLHA-DD's perspectives on barriers to initiation/continuation of HAART; and (2) develop components of an intervention and examine their acceptability, safety, feasibility, and gather preliminary evidence of efficacy with respect to HAART initiation/continuation. To accomplish these aims, we propose a three phase study: (1) Elicitation, to study the perspectives of providers (N=18) and PLHA-DD (N=16); (2) Development, to create intervention components; and (3) Evaluation, to test and revise intervention components (N=80 PLHA-DD; 50% African-American, 50% Latino/Hispanic recruited from two large HIV clinics). The proposed study is innovative in that it seeks to broaden the HAART adherence research paradigm to include HAART initiation. Although PLHA-DD are a modest proportion of the population, effective interventions to reduce morbidity, increase longevity, reduce health care costs, and increase viral load suppression among PLHA-DD have high public health significance. PUBLIC HEALTH RELEVANCE: This study addresses racial/ethnic disparities in HIV/AIDS treatment. Many persons living with HIV/AIDS (PLHA) in the U.S. (10-19% of PLHA), predominantly African-Americans and Latinos, delay taking Highly Active Antiretroviral Therapy (HAART) until late in the course of their HIV disease or never initiate HAART when it is medically indicated. However, there are no behavioral interventions to increase HAART initiation among PLHA who delay or decline HAART ("PLHA-DD"). The overarching aim of the proposed study is to develop a flexible, targeted, and sustainable behavioral intervention to increase HAART initiation among PLHA-DD, which, if efficacious, will lead to reductions in morbidity, early mortality, and health care costs, as well as increased viral load suppression (reducing transmission to others). Further, the study complements and primes participants for existing adherence interventions, from which PLHA-DD can benefit when they initiate HAART.