Community-based accompaniment with supervised antiretrovirals in Lima, Peru

描述（由申请人提供）：我们提出了一项集群随机试验，以评估基于社区的DOT-HAART对秘鲁利马艾滋病毒阳性个体和社区成员的影响。我们将招募因病毒学失败而开始一线高效抗逆转录病毒疗法或补救性治疗的极端贫困人群。居住在干预组的患者将接受12个月的DOT-HAART治疗。我们的目标是1)评估在开始HAART治疗后18个月和24个月接受社区DOT-HAART治疗的患者与对照组相比HIV病毒载量受到抑制的比例；2)比较DOT-HAART社区成员与对照组社区成员的社会资本；3)评估基于社区的DOT-HAART的成本效益。该建议的创新之处包括：1)针对开始HAART治疗的最脆弱人群（即生活在极端贫困中的人）进行有针对性的干预；2)以社区为基础的DOT-HAART干预，旨在实现长期疗效；3)成本效益分析；4)社区层面社会资本干预效果评价。这些研究内容将为如何在秘鲁和其他资源贫乏的环境中最好地设计和实施dots - haart战略提供信息。通过为资源贫乏的环境提供一种实用、有效和具有成本效益的DOT-HAART模式，本研究的发现可以促进全球努力，在接受HAART治疗的个体中实现良好的长期临床结果。

DESCRIPTION (provided by applicant): We propose a cluster-randomized trial to assess the impact of community-based DOT-HAART on HIV-positive individuals and community members in Lima, Peru. We will enroll individuals living in extreme poverty who are starting either first-line HAART or salvage therapy due to virologic failure. Those residing in intervention clusters will receive 12 months of DOT-HAART. We aim to 1) assess the proportion with suppressed HIV viral load at 18 and 24 months after starting HAART among those receiving community-based DOT-HAART versus the control group; 2) compare social capital among community members in DOT-HAART versus control communities; and 3) assess the cost-effectiveness of community-based DOT-HAART. Innovative aspects of this proposal include 1) a targeted intervention for the most vulnerable subgroup of individuals starting HAART (i.e. those living in extreme poverty); 2) a community- based DOT-HAART intervention designed specifically to achieve long-term efficacy; 3) cost- effectiveness analysis; and 4) assessment of the intervention effect on community-level social capital. These study components will inform how best to design and implement DOT-HAART strategies in Peru and other resource-poor settings. By offering a practical, efficacious and cost-effective model of DOT-HAART for resource-poor settings, the findings of this study could improve global efforts to achieve excellent long-term clinical outcomes among individuals on HAART.