Increasing Motivation for Antiretroviral Therapy Initiation: A Pilot Intervention

描述（由申请人提供）：拟议的研究旨在通过开发和试点测试动机访谈干预来支持患者开始抗逆转录病毒治疗（ART）的决策，并增强开始抗逆转录病毒治疗的动机，从而减少艾滋病毒治疗结果的种族差异。抗逆转录病毒疗法大大延长了艾滋病毒感染者的生命，减少了他们的痛苦，但许多符合临床条件的患者拒绝接受抗逆转录病毒疗法。其他人在没有通知医疗提供者的情况下停止了抗逆转录病毒治疗。尽管对抗逆转录病毒治疗的依从性进行了广泛的研究，但对导致患者接受或拒绝抗逆转录病毒治疗的因素知之甚少。我们的初步研究表明，许多患者对抗逆转录病毒治疗持矛盾态度，而诸如相信艾滋病毒阴谋论和不信任医疗系统等认知因素可能导致不愿开始或继续抗逆转录病毒治疗。我们建议发展一种基于认知理论的干预措施，主要使用动机性访谈技术来削弱信念障碍，减少对ART启动的矛盾心理。感兴趣的人群是市中心感染艾滋病毒的非洲裔美国人，他们目前没有接受抗逆转录病毒治疗，也没有得到最佳的治疗。干预措施将在艾滋病毒门诊诊所和艾滋病服务组织（ASO）环境中进行测试。社区顾问和专家顾问将为干预方案的发展和迭代改进做出贡献。该方案将首先在一个小的非控制病例系列（n=10）中进行测试，然后在一个更大的随机试验（n=80）中进行测试，旨在初步测试干预措施对关键态度措施的影响（感知到的抗逆转录病毒治疗障碍、开始治疗的动机）、适当的艾滋病毒医疗保健利用以及与仅关注对照相比的抗逆转录病毒治疗的开始。将确定并解决在门诊诊所和ASO环境中实施干预的制度障碍。如果干预的初步试验提供积极的结果，则计划使用本研究中制定的干预手册进行更大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启动抗逆转录病毒治疗的目标方面具有高度创新性。

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.