Increasing Motivation for Antiretroviral Therapy Initiation: A Pilot Intervention

描述（申请人提供）：这项拟议的研究旨在通过开发和试点测试动机访谈干预来减少艾滋病毒治疗结果的种族差异，以支持患者关于抗逆转录病毒治疗（ART）开始的决策，并增强抗逆转录病毒治疗开始ART的动机。抗逆转录病毒治疗大大延长了艾滋病毒感染者的生命，减少了他们的痛苦，但许多临床上符合条件的患者拒绝接受ART治疗。其他人在没有通知医疗提供者的情况下停止ART治疗。虽然对ART的依从性进行了广泛的研究，但对导致患者完全接受或拒绝ART的因素知之甚少。我们的初步研究表明，许多患者对ART的矛盾，以及认知因素，如艾滋病毒阴谋论和不信任的医疗系统的信念可能会导致不愿意启动或继续ART。我们建议开发一种基于认知理论的干预，主要使用动机访谈技术，以削弱信仰障碍，减少矛盾的ART启动。感兴趣的人群是目前未接受抗逆转录病毒治疗且护理效果欠佳的市中心非裔美国人艾滋病毒感染者。该干预措施将在艾滋病门诊诊所和艾滋病服务组织（阿索）进行测试。社区顾问和专家顾问将为制定和反复完善干预方案做出贡献。该方案将首先在一个小型非对照病例系列（n=10）中进行测试，然后在一个较大的随机试点（n=80）中进行测试，旨在初步测试干预措施对关键态度措施（对ART的感知障碍，开始治疗的动机）的影响，适当的HIV医疗保健利用，以及与仅注意力控制相比的ART启动。将确定和解决在门诊和阿索环境中实施干预的制度障碍。如果干预措施的初步试验提供了阳性结果，则计划使用当前拟定研究中开发的干预手册进行一项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及其ART启动目标方面具有高度创新性。 公共卫生相关性：艾滋病毒阴谋信念是广泛的非洲裔美国人与艾滋病毒，有很大的理由相信，这些信念产生负面影响的治疗结果，有助于抗逆转录病毒治疗（ART）的拒绝，延迟，或不遵守。拟议的研究将开发一种简短的干预措施，通过解决阴谋信念和其他认知障碍来提高非洲裔美国艾滋病毒感染者的ART启动率。如果成功，它有可能减少艾滋病毒治疗结果的种族差异，并改善非洲裔美国人感染艾滋病毒的健康和生存。

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.