Increasing Motivation for Antiretroviral Therapy Initiation: A Pilot Intervention

描述(申请人提供)：拟议的研究旨在通过开发和试点测试激励性访谈干预措施来支持患者关于开始抗逆转录病毒治疗(ART)的决策，并增强开始抗逆转录病毒治疗(ART)的动机，从而减少艾滋病毒治疗结果中的种族差异。抗逆转录病毒治疗极大地延长了艾滋病毒携带者的生命，减少了他们的痛苦，但许多符合临床条件的患者拒绝接受抗逆转录病毒治疗。其他人在没有通知医疗提供者的情况下停止了ART。尽管对抗逆转录病毒治疗的依从性进行了广泛的研究，但人们对导致患者完全接受或拒绝抗逆转录病毒治疗的因素知之甚少。我们的初步研究表明，许多患者对抗逆转录病毒治疗持矛盾态度，而诸如对艾滋病毒阴谋论的信仰和对医疗系统的不信任等认知因素可能导致不愿启动或继续抗逆转录病毒治疗。我们建议开发一种基于认知理论的干预措施，主要使用动机访谈技术来削弱信念障碍，减少对艺术启动的矛盾心理。感兴趣的人群是市中心感染艾滋病毒的非裔美国人，他们目前没有接受抗逆转录病毒治疗，正在接受次优的护理。该干预措施将在艾滋病毒门诊和艾滋病服务组织(ASO)的环境中进行测试。社区顾问和专家顾问将为干预议定书的制定和反复完善作出贡献。该方案将首先在一个小型的非对照病例系列(n=10)中进行测试，然后在一个更大的随机试点(n=80)中进行测试，该试验旨在与仅注意的对照相比，初步测试干预措施对关键态度措施(感知到的抗逆转录病毒疗法障碍、开始治疗的动机)、适当的艾滋病毒医疗保健利用以及抗逆转录病毒疗法启动的影响。将确定和解决在门诊和ASO环境中实施干预的体制障碍。如果干预的初步测试提供了积极的结果，则计划使用本拟议研究中开发的干预手册，进行更大规模的随机对照试验设计的R01研究。该项目在关注艾滋病毒阴谋论信仰和启动抗逆转录病毒治疗的目标方面具有很高的创新性。 与公共卫生相关：艾滋病毒阴谋论在感染艾滋病毒的非裔美国人中很普遍，有很大理由相信这些信念会导致抗逆转录病毒疗法(ART)拒绝、延迟或不遵守，从而对治疗结果产生负面影响。这项拟议的研究将开发一种简短的干预措施，通过解决阴谋论信念和使用抗逆转录病毒药物的其他认知障碍来提高感染艾滋病毒的非裔美国人的抗逆转录病毒治疗启动率。如果成功，它有可能减少艾滋病毒治疗结果中的种族差异，并改善携带艾滋病毒的非裔美国人的健康和生存。

DESCRIPTION (provided by applicant): The proposed study is designed to reduce racial disparities in HIV treatment outcomes by developing and pilot-testing a Motivational Interviewing intervention to support patient decision-making about antiretroviral therapy (ART) initiation and to enhance motivation to begin ART. Antiretroviral therapy has dramatically extended the lives and reduced the suffering of people with HIV, but many clinically eligible patients refuse ART. Others stop ART without notifying their medical providers. Although adherence to ART has been extensively studied, much less is known about factors which lead patients to accept or reject ART altogether. Our preliminary studies indicate that many patients are ambivalent about ART, and that cognitive factors such as a belief in HIV conspiracy theories and mistrust of the medical system may contribute to reluctance to initiate or continue ART. We propose to develop an intervention grounded in cognitive theory which primarily uses Motivational Interviewing techniques to weaken belief barriers and reduce ambivalence about ART initiation. The population of interest is inner-city African- Americans with HIV who are not currently receiving ART and are suboptimally engaged in care. The intervention will be tested both in an HIV outpatient clinic setting and an AIDS Service Organization (ASO) setting. Community advisors and expert consultants will contribute to the development and iterative refinement of the intervention protocol. The protocol will be tested first in a small uncontrolled case series (n=10), and then in a larger randomized pilot (n=80) designed to allow preliminary tests of the intervention's effects on key attitudinal measures (perceived barriers to ART, motivation to begin treatment), appropriate HIV medical care utilization, and ART initiation compared to an attention-only control. Institutional barriers to implementing the intervention in the outpatient clinic and ASO settings will be identified and addressed. If the preliminary tests of the intervention provide positive results, then a larger R01 study with a randomized controlled trial design is planned, using the intervention manual developed in the present proposed study. This project is highly innovative in its focus on HIV conspiracy beliefs and its target of ART initiation. PUBLIC HEALTH RELEVANCE: HIV conspiracy beliefs are widespread among African-Americans with HIV, and there is significant reason to believe that these beliefs negatively affect treatment outcomes by contributing to antiretroviral therapy (ART) refusal, delay, or nonadherence. The proposed research will develop a brief intervention to improve rates of ART initiation among African-Americans with HIV by addressing conspiracy beliefs and other cognitive barriers to ART use. If successful, it has the potential to decrease racial disparities in HIV treatment outcomes and improve health and survival for African-Americans living with HIV.