Positive Connections

描述（由申请人提供）：阿根廷人口超过4000万，估计有8.8万至15万人感染艾滋病毒（联合国艾滋病规划署/世界卫生组织，2008年~国家艾滋病规划），估计患病率为成人人口的0.5%（联合国艾滋病规划署，2009年）。艾滋病毒/艾滋病在阿根廷的流行曾经主要发生在高风险人群中，现在正转向异性恋人群，异性恋传播占男性艾滋病毒感染的48%，占女性艾滋病毒感染的87% （Pando等人，2010年），使其成为增长最快的传播群体（Cohen等人，2006年）。阿根廷政府向所有需要的人提供抗逆转录病毒药物，并已向大约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药物治疗的效益，就必须系统地将教育和动机纳入艾滋病毒护理，以优化艾滋病毒阳性个体的坚持治疗水平。鉴于阿根廷获得抗逆转录病毒治疗（ART）的水平，优化抗逆转录病毒治疗依从性可以作为一种非常有效的预防策略对感染者和未感染者产生重大影响，以遏制疫情（Lima, 2008~ Montaner， 2010~ Velaszco- Hernandez等人，2002）。本研究旨在通过促进患者-提供者伙伴关系和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。与患者和提供者合作，本研究利用生物行为策略来提高参与度，治疗和保留，并增强患者对病毒抑制在改善健康和减少艾滋病毒传播中的作用的理解。拟议的申请旨在开发、调整和试点测试一种创新的患者-提供者干预措施，即阿根廷积极联系（Conexiones y Opciones Positivas en la Argentina， COPA），旨在1)提高艾滋病毒/抗逆转录病毒治疗知识，2)调整向患者提供的信息水平，3)加强提供者-患者治疗沟通。这项研究将在患者-提供者干预中招募新诊断的ARVs新患者（n = 120）和提供者（n = 12）。采用全因子设计，患者将被随机分为四种情况之一：1)患者/实验-提供者/实验~ 2)患者/实验-提供者/护理标准~ 3)患者/护理标准-提供者/实验~和4)患者/护理标准-提供者/护理标准。从这四种情况中收集的数据将指导临床试验的发展，以在更大、更有代表性的目标人群中测试最有效的患者-提供者干预措施。利用现有的抗逆转录病毒药物分发基础设施，优化患者和提供者之间的协同作用，可以成为阿根廷坚持治疗的一个关键组成部分，成为一项有效的预防战略。

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.