Reaching and Engaging Community PLH Into Care Through Their Social Networks

描述（由申请人提供）：病毒载量受到抑制的艾滋病毒感染者（PLH）将其感染传染给性伴侣的可能性要小得多，从而产生了ART作为治疗和预防的概念。在公共卫生规模上，治疗即预防战略的成功要求所有艾滋病毒携带者中有很高比例的人参与护理。尽管在如何将新诊断的PLH与护理联系起来方面取得了进展，但在已被诊断为艾滋病毒感染的100万美国人中，有近一半生活在社区中，但目前没有接受治疗。在这500 000名艾滋病毒携带者得到医疗护理之前，他们的健康受到威胁，以治疗为预防的做法无法实现其最大的公共卫生影响。该领域目前缺乏干预战略，可以达到照顾外的艾滋病毒携带者在社区，治疗级联中的一个未解决的差距。由于艾滋病毒携带者往往与其他艾滋病毒阳性者有社会联系，社会网络方法是接触社区艾滋病毒携带者并提供干预的一种有希望的方式。这项研究将开发和试点测试一种新的网络级社区干预，以提高护理参与。混合方法研究将分两个阶段进行。最初的定性阶段将包括与大约50名从未接受护理的艾滋病毒携带者、退出艾滋病毒医疗护理的艾滋病毒携带者和其他关键知情人进行深入访谈。数据将进行分析，以检查PLH的观点，动机，障碍和医疗参与的促进者;确定环境和方法，以获得护理外PLH;从PLH社区及其利益相关者的研究投入;并定制干预内容。第二个研究阶段是一个小型的随机概念测试试点研究，以确定网络级干预的初步疗效。将在社区招募10名无护理MSM PLH种子（一半是非洲裔美国MSM）。每粒种子将带来研究的朋友也知道艾滋病毒+。当招募时，这些第一环朋友也会招募他们自己的HIV+朋友，导致10个二环PLH社会中心网络的累积（预期n=120个个体）。参与者将在基线评估近期护理出勤率，CD 4+和HIV病毒载量，ART依从性，风险实践和心理社会特征。然后将随机分配5个网络以接受网络干预。将确定、培训和指导干预条件网络的领导者， 提供持续的，基于理论的，个人定制的建议，以PLH的朋友有关治疗的好处和战略进入，保持，并坚持医疗保健。我们将在6个月随访时确定干预是否增加了网络成员的护理参与，这是主要结局。将检查干预对治疗依从性、病毒载量和心理社会量表次要结局的影响。如果探索性研究产生了初步的益处证据，随后将提出全面试验。待测试的网络干预有可能接触并吸引社区中更多的PLH进入护理，这是治疗级联中的一个关键但被忽视的点。

DESCRIPTION (provided by applicant): Persons living with HIV (PLH) with suppressed viral load are much less likely to transmit their infection to sexual partners, giving rise to a conceptualization of ART as both treatment and also prevention. The success of a treatment-as-prevention strategy on a public health scale requires that a high proportion of all PLH are engaged in care. Although advances are being made in how to link newly-diagnosed PLH to care, nearly half of the one million Americans already diagnosed with HIV infection are living in the community but not presently in treatment. Until these 500,000 PLH are in medical care, their health is threatened and treatment-as-prevention cannot achieve its maximum public health impact. The field presently lacks intervention strategies that can reach out-of-care PLH in the community, an unaddressed gap in the treatment cascade. Because PLH are often socially connected with other HIV+ persons, social network approaches represent a promising way to reach PLH in the community and also deliver intervention. This research will develop and pilot test a novel network-level community intervention to improve care engagement. The mixed-methods research will occur in two phases. The initial qualitative phase will include in-depth interviews with approximately 50 PLH who never entered care, PLH who dropped out of HIV medical care, and other key informants. Data will be analyzed to examine PLH views, motivations, barriers, and facilitators of medical engagement; identify settings and ways to access out-of-care PLH; elicit research input from the PLH community and its stakeholders; and tailor intervention content. The second research phase is a small randomized test-of-concept pilot study to determine preliminary efficacy of the network-level intervention. 10 out-of-care MSM PLH seeds (half African American MSM) will be recruited in the community. Each seed will bring into the study friends known to also by HIV+. When enrolled, these first-ring friends will, in turn, also recruit their own HIV+ friends, resulting in the accrual of 10 2-ring PLH sociocentric networks (expected n=120 individuals). Participants will be assessed at baseline for recent care attendance, CD4+ and HIV viral load, ART adherence, risk practices, and psychosocial characteristics. Five networks will then be randomized to receive the network intervention. Leaders in intervention condition networks will be identified, trained, and guided to deliver ongoing, theory-based, personally tailored advice to PLH friends about treatment benefits and about strategies to enter, remain, and adhere to medical care. We will determine if the intervention increases network member care engagement at 6-month follow up, the primary outcome. Effects of intervention on secondary outcomes of treatment adherence, viral load, and psychosocial scales will be examined. If the exploratory study produces preliminary evidence of benefit, a full-scale trial will later be proposed. The network intervention to be tested has the potential to reach and engage more PLH in the community to enter care, a critical but neglected point in the treatment cascade.