ART Adherence and Secondary Prevention of HIV

ART 依从性和 HIV 二级预防

• 批准号: 8501618
• 负责人: NANCY M PETRY
• 金额: $ 66.19万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8501618
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Alcohol or Other Drugs use; Anti-Retroviral Agents; Behavior; Behavioral; Behavioral Sciences; Caring; Cellular Phone; Clinic; Cognitive deficits; Communicable Diseases; Communication; Communities; Data; Drug resistance; Drug usage; Effectiveness of Interventions; Exhibits; Goals; HIV; HIV Seropositivity; HIV drug resistance; Health; Individual; Information Management; Ingestion; Intervention; Measures; Meta-Analysis; Methods; Monitor; Outcome; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Prevention; Psychological reinforcement; Psychologist; Quality of life; Randomized; Relative (related person); Risk Behaviors; Science; Secondary Prevention; Self Efficacy; Specialist; Substance Use Disorder; Symptoms; Techniques; Technology; Time; Viral Load result; Vulnerable Populations; antiretroviral therapy; base; behavioral/social science; clinical practice; contingency management; cost; cost effectiveness; depressive symptoms; effective intervention; follow-up; high risk; improved; indexing; intervention effect; intravenous drug use; medication compliance; multidisciplinary; new technology; novel; prevent; primary outcome; psychosocial; reinforcer; resistant strain; social science research; standard care; success; transmission process; treatment duration

DESCRIPTION (provided by applicant): ART adherence and secondary prevention of HIV Anti-retroviral medications (ART) prevent the progression of HIV. However, substantial proportions of HIV positive individuals fail to adhere adequately to ART, resulting in spread of potentially drug-resistant strains to the community. A low cost method to boost ART adherence and thereby reduce the spread of HIV involves cell phone reminders, and our preliminary study (Hardy et al., 2011) finds significant effects of cell phone reminders for improving adherence. Contingency management (CM) also shows promise for improving ART adherence. CM involves providing tangible reinforcement each time the behavior (medication ingestion) is exhibited. Studies evaluating CM for increasing ART adherence have relied upon MEMS caps, but reinforcement of adherence via MEMS caps is done relatively infrequently and with delay, hindering its efficacy. Cell phones allow for reinforcement of adherence in real time. Because effect sizes of CM interventions are larger the more immediately the reinforcement is paired with the behavior targeted for change, integration of cell phone based reinforcement should improve adherence beyond reminders alone. Pilot data show feasibility, acceptability, and initial efficacy of cell phone administered CM using videoing recording techniques to verify medication adherence. Moreover, effective CM interventions have been shown to reduce risk behaviors in high-risk populations. In this study, we propose to randomize 165 HIV-positive patients to one of three 16-week treatment conditions: (1) standard care; (2) standard care + cell phone-based adherence reminders; or (3) standard care + cell phone-based adherence reminders and CM. In this latter condition, patients will earn reinforcement for sending in time- and date-stamped self videos of ART ingestion. Primary outcomes will include self-report measures of adherence and objective indices of viral loads, and effects will be evaluated both during the treatment period and throughout a one-year follow-up. Effects of these interventions on risk behaviors will be evaluated as well. We hypothesize that the cell phone reminder condition will improve adherence relative to standard care, and the cell phone reminder plus CM condition will have the best outcomes. We will also estimate the cost-effectiveness of these interventions. Results from this study may have widespread implications for the use of cell phones as a novel technology to improve initial adherence to ART, thereby reducing the spread of drug resistant HIV strains to the community.

描述（由申请人提供）：抗逆转录病毒药物（ART）可预防艾滋病毒的进展。然而，相当大比例的艾滋病毒阳性个体未能充分坚持抗逆转录病毒疗法，导致潜在耐药菌株向社区传播。一种促进ART依从性从而减少HIV传播的低成本方法涉及手机提醒，我们的初步研究（哈代等人，2011）发现手机提醒对提高依从性的显著影响。应急管理（CM）也显示出改善ART依从性的希望。CM涉及每次行为（药物摄入）被展示时提供有形的强化。评估CM增加ART依从性的研究依赖于MEMS帽，但通过MEMS帽加强依从性的情况相对较少，并且延迟，阻碍了其疗效。手机可以在真实的时间里加强坚持。由于CM干预的效果大小越大，强化与针对改变的行为配对的越直接，基于手机的强化的整合应该不仅仅是提醒，而是提高依从性。试验数据显示了手机管理CM的可行性，可接受性和初步疗效，使用录像记录技术来验证药物依从性。此外，有效的CM干预措施已被证明可以减少高危人群的风险行为。 在这项研究中，我们建议将165名HIV阳性患者随机分配到三种16周治疗条件之一：（1）标准护理;（2）标准护理+基于手机的坚持提醒;或（3）标准护理+基于手机的坚持提醒和CM。在后一种情况下，患者将通过发送带有时间和日期戳的自我ART摄入视频来获得强化。主要结局将包括依从性的自我报告测量和病毒载量的客观指数，并将在治疗期间和整个一年随访期间评估效果。这些干预措施对危险行为的影响也将得到评估。我们假设，手机提醒条件将提高相对于标准护理的依从性，手机提醒加CM条件将有最好的结果。我们还将评估这些干预措施的成本效益。这项研究的结果可能对使用手机作为一种新技术来改善对ART的初始依从性具有广泛的影响，从而减少耐药HIV菌株向社区的传播。