Positive Connections

描述（申请人提供）：阿根廷人口超过4000万，估计有88，000至150，000人感染艾滋病毒（联合国艾滋病规划署/世界卫生组织，2008年~国家艾滋病规划署），估计患病率为成年人口的0.5%（联合国艾滋病规划署，2009年）。阿根廷的艾滋病毒/艾滋病流行病曾经主要发生在高危人群中，现在正在向异性恋人群转移，异性恋传播占男性艾滋病毒的48%，女性艾滋病毒的87%（Pando et al.，2010），使他们成为增长最快的传播群体（Cohen等人，2006年）。阿根廷政府已向所有需要者提供抗逆转录病毒药物，并已向约70%的艾滋病毒感染者分发了抗逆转录病毒药物（艾滋病规划署/世卫组织，2008年）。 然而，如果要最大限度地发挥大规模提供抗逆转录病毒治疗的好处，就必须将教育和激励措施系统地纳入艾滋病毒护理，以优化艾滋病毒阳性者的坚持程度。考虑到阿根廷抗逆转录病毒疗法（ART）的可及性水平，优化ART依从性可以显著影响感染者和未感染者，作为控制流行病的高效预防策略（Lima，2008~ Montaner，2010~ Velaszco-埃尔南德斯等人，2002年）。这项研究旨在通过促进患者-提供者伙伴关系和对新诊断的抗逆转录病毒药物新患者的治疗联系来优化治疗结果。这项研究与患者和提供者合作，利用生物行为策略来改善参与，治疗和保留，并提高患者对病毒抑制作用的理解，以改善健康和减少艾滋病毒传播。拟议的应用程序旨在开发，调整和试点测试创新的患者-提供者干预措施，Conexiones y Opciones Positivas en la Argentina（积极联系，COPA），旨在1）提高艾滋病毒/ART知识，2）调整提供给患者的信息水平，3）加强提供者-患者治疗沟通。本研究将在患者-提供者干预中招募新诊断的ARV新患者（n = 120）和提供者（n = 12）。使用全析因设计，患者将被随机分配到四种条件之一：1）患者/实验-提供者/实验~ 2）患者/实验-提供者/标准护理~ 3）患者/标准护理-提供者/实验~和4）患者/标准护理-提供者/标准护理。从这四种情况中收集的数据将指导临床试验的开发，以测试最有效的患者-提供者干预，目标人群的样本量更大，更具代表性。利用现有的抗逆转录病毒药物分配基础设施，优化患者和提供者之间的协同作用，可能成为阿根廷坚持有效预防战略的关键组成部分。

DESCRIPTION (provided by applicant): With a population of over 40 million people, Argentina has an estimated 88,000 to 150,000 persons living with HIV (UNAIDS/WHO, 2008~ National AIDS Program), with an estimated prevalence of 0.5% of the adult population (UNAIDS, 2009). Once primarily among high risk groups, the HIV/AIDS epidemic in Argentina is now shifting to the heterosexual population and heterosexual transmission accounts for 48% of HIV in men and 87% in women (Pando et al., 2010), making them the fastest growing transmission group (Cohen et al., 2006). The Government of Argentina has made antiretroviral (ARV) medications available to all who need it and has already distributed ARVs to approximately 70% of the HIV infected population (UNAIDS/WHO, 2008). However, if the benefits of large scale provision of ARV therapy are to be maximized, education and motivation to optimize the level of adherence among HIV positive individuals must be systematically incorporated into HIV care. Given the level of access to antiretroviral therapy (ART) in Argentina, optimizing ART adherence could significantly impact both those infected and uninfected as a highly effective prevention strategy to contain the epidemic (Lima, 2008~ Montaner, 2010~ Velaszco- Hernandez et al., 2002). This study seeks to optimize treatment outcomes by facilitating patient-provider partnerships and treatment linkages for newly diagnosed patients new to ARVs. Working with both patients and providers, this study utilizes bio-behavioral strategies to improve engagement, treatment and retention, and to enhance patients' understanding of the role of viral suppression to improve health and reduce HIV transmission. The proposed application seeks to develop, adapt and pilot test an innovative patient-provider intervention, Conexiones y Opciones Positivas en la Argentina (Positive Connections, COPA) designed to 1) enhance HIV/ART knowledge, 2) tailor the level of information provided to patients, and 3) enhance provider-patient treatment communication. This study will enroll newly diagnosed patients new to ARVs (n = 120) and providers (n = 12) in a patient- provider intervention. Using a full factorial design, patients wil be randomized into one of four conditions: 1) Patient/Experimental - Provider/Experimental~ 2) Patient/Experimental - Provider/Standard of Care~ 3) Patient/Standard of Care - Provider/Experimental~ and 4) Patient/Standard of Care - Provider/Standard of Care. The data gathered from the four conditions will guide the development of a clinical trial to test the most efficacious patient-provider intervention with a larger, more representative sample of the target population. Utilizing the existing ARV distribution infrastructure, optimizing the synergy between patient and provider could become a critical component of adherence as an effective prevention strategy in Argentina.