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

描述（由申请人提供）：早期接受并坚持抗逆转录病毒治疗对于有效治疗艾滋病毒至关重要。但必要的第一步是参与并坚持艾滋病毒护理。艾滋病毒阳性的拉丁美洲人迫切需要干预措施，以提高他们在艾滋病毒护理中的保留率，这可能受到一些文化特定因素的影响。本提案的目标是在文化上适应和定制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艾滋病毒+拉丁美洲人的文化敏感性、可行性和可接受性，并在一项小型随机对照试验中进行测试（n=30干预；n=30对照）。这项研究将在艾滋病毒阳性的拉丁裔人中进行，这些人在前一年至少安排了一次到洛杉矶最大的拉丁裔艾滋病毒医疗服务提供商AltaMed就诊。拟议的干预措施旨在通过使用基于小组的、一对一的、基于同伴的学习方法，解决拉丁美洲人面临的艾滋病毒护理障碍和促进因素，从而保留艾滋病毒护理的参与者。该提案有三个主要的具体目标：开展一项小型形成性质的研究，为旨在改善艾滋病毒阳性拉丁美洲人艾滋病毒护理保留率的干预措施的适应和定制提供信息；2. 利用对干预措施的定性输入，为拉丁裔艾滋病毒感染者调整和定制干预措施，并对干预措施进行小规模的预测试，以进一步提高其可行性、可接受性和文化敏感性。3. 对干预措施进行试点试验，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，我们的目的是评估干预对HIV护理的保留、自我报告的依从性和临床结果的初步影响，包括HIV RNA病毒载量和与健康相关的生活质量。此外，我们将研究干预目标变量（例如，艾滋病毒保留知识，结果预期和自我效能）和其他潜在中介（例如，感知耻辱，物质使用和其他社会心理变量以及背景特征）之间艾滋病毒护理保留的相关性。如果干预被证明是可行的、可接受的和有效的，那么结果将被用于准备R-01提案，以进行全动力的随机干预。最终，这种干预可能会对美国各地艾滋病毒+拉丁裔患者的医疗保健产生重大而广泛的影响，那里有大量艾滋病毒+拉丁裔患者接受护理。这一建议寻求超越传统的依从性研究的焦点，即服用药物，以解决影响治疗依从性的第一个必要步骤的更广泛的文化和社会因素：艾滋病毒护理的保留。

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.