Treatment Advocacy Intervention for HIV-Postive African Americans

HIV 阳性非裔美国人的治疗倡导干预

基本信息

批准号：
8402555
负责人：
Laura M Bogart
金额：
$ 34.78万
依托单位：
BOSTON CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-05-01 至 2015-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8402555
关键词：
Acquired Immunodeficiency Syndrome Address Adherence Adverse effects Advocacy Advocate African American Alcohol or Other Drugs use Anti-Retroviral Agents Behavior Behavior Therapy Behavioral Caring Client Client satisfaction Communities Control Groups Coping Skills Counseling County Discrimination Education Educational process of instructing Epidemic Ethnic Origin Evaluation HIV HIV Seropositivity Health Health Personnel Health behavior Healthcare Housing Imprisonment Individual Intervention Knowledge Los Angeles Mediating Mediator of activation protein Medical Mental Depression Mental Health Monitor Navigation System Outcome Participant Patients Poverty Process Professional counselor Provider Psychosocial Influences Race Randomized Randomized Controlled Trials Recruitment Activity Research Sampling Services Social Conditions Social Work Social support Spirituality Staging Stress Structure Substance abuse problem Surveys System Testing Trauma Treatment Efficacy Waiting Lists Work base community organizations community setting coping group intervention health disparity improved innovation intervention effect novel parity post intervention programs public health relevance racial and ethnic racial and ethnic disparities racism response screening skills social social stigma treatment adherence treatment effect

项目摘要

DESCRIPTION (provided by applicant): Compared to other races/ethnicities, African Americans with HIV have lower levels of engagement in care, are less likely to be on antiretroviral treatment (ART), and are more likely to delay care and ART initiation; those on ART are less likely to be adherent at high enough levels for the treatment to be effective. We propose to test an innovative, culturally relevant treatment advocacy (TA) intervention for African Americans with HIV that targets social and cultural issues contributing to poor HIV treatment behaviors. TA, which has been sustained in many community organizations throughout the HIV epidemic, has never been systematically evaluated. TA facilitates patient navigation through the medical system and provides tailored HIV treatment education and client-centered counseling to improve adherence and engagement in care. TA targets social and contextual issues in healthcare and patients' lives by advocating to providers to improve patient-provider relationships, recommending changes in treatment and/or providers (if needed), and referring patients to mental health and social services. TA is particularly appropriate for African Americans with HIV, who may be mistrustful of providers: it can be conducted outside of the medical system in a safe, neutral community setting by individuals not associated with patients' healthcare. We developed a culturally relevant TA program that additionally discusses factors such as racism that undermine healthcare in Black communities, by acknowledging and directly addressing patients' medical mistrust and stigma as coping strategies that arise in response to oppression. The specific aims are to (1) conduct a randomized controlled trial to examine the effects of a culturally relevant TA program on adherence among African Americans with HIV; (2) identify culturally relevant mediators that explain the effects of treatment advocacy on antiretroviral treatment adherence among African Americans with HIV (e.g., improved behavioral adherence skills, coping with stress/discrimination, mental health, and patient satisfaction; lower levels of HIV misconceptions, internalized HIV stigma/homophobia, medical mistrust, and substance use); and (3) explore culturally relevant moderators of the effects of treatment advocacy on antiretroviral treatment adherence among African Americans with HIV (e.g., discrimination, incarceration, poverty, social support, spirituality, trauma). A sample of 200 African Americans with HIV will be randomly assigned to a TA intervention or wait-list control group. Participants will complete surveys at screening, and at 3- and 6-months post-baseline, to assess pre-, intra-, and post- intervention effects on adherence.

描述（由申请人提供）：与其他种族/族裔相比，患有艾滋病毒的非裔美国人参与护理水平较低，不太可能接受抗逆转录病毒治疗（ART），并且更有可能延迟护理和艺术启动；那些艺术上的人不太可能在足够高的水平上粘附以使治疗有效。我们建议对患有艾滋病毒的非洲裔美国人进行创新的，文化相关的治疗倡导（TA）干预，该干预措施针对社会和文化问题，导致艾滋病毒较差的治疗行为。 TA在整个艾滋病毒流行病的许多社区组织中都维持下来，但从未进行过系统评估。 TA促进患者通过医疗系统的导航，并提供量身定制的HIV治疗教育和以客户为中心的咨询，以提高依从性和护理的依从性。 TA通过主张提供者改善患者提供者的关系，建议治疗和/或提供者的变化（如果需要），并将患者参考心理健康和社会服务来定位医疗保健和患者生活中的社会和情境问题。 TA特别适合患有艾滋病毒的非洲裔美国人，他们可能对提供者不信任：它可以由与患者医疗保健无关的个人在安全，中立的社区中在医疗系统之外进行。我们开发了一项与文化相关的TA计划，该计划还讨论了种族主义等因素，这些因素是通过承认并直接解决患者的医疗不信任和污名作为应对压迫而产生的应对策略来破坏黑人社区中医疗保健的因素。具体的目的是（1）进行一项随机对照试验，以检查与艾滋病毒艾滋病毒的非裔美国人依从性依从性的文化相关计划的影响；（2）确定与文化相关的介体解释治疗倡导对HIV的非洲裔美国人（例如，改善行为依从能力，应对压力/歧视，心理健康和患者满意度的改善的行为依从能力和患者满意度； HIV误解的水平较低，内部HIV HIV/HOMOPHABIA，医疗用法，和异性，（3）探索与文化相关的主持人的治疗倡导对艾滋病毒抗逆转录病毒治疗的影响的影响（例如，歧视，监禁，贫困，社会支持，灵性，创伤）。将有200名艾滋病毒的非裔美国人的样本随机分配给TA干预或候补名单对照组。参与者将在筛查时完成调查，并在3个月后3个月和6个月进行评估，以评估对依从性的前，内和干预后的影响。