Increasing Social Support to Improve HIV Care Engagement and Adherence

增加社会支持以提高艾滋病毒护理参与度和依从性

• 批准号: 8605765
• 负责人: Yuri A Amirkhanian
• 金额: $ 19.6万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8605765
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Alcohol or Other Drugs use; Anti-Retroviral Agents; Appointment; Attitude; Awareness; Behavioral; Bilateral; Biological; Biomedical Research; Caring; Cities; Collaborations; Communities; Counseling; Data; Data Analyses; Development; Diagnosis; Disease; Distress; Drug usage; Drug user; Enrollment; Epidemic; Face; Family; Foundations; Friends; Friendships; Future; Goals; HIV; HIV Infections; Health; Health Benefit; Health behavior; Heterosexuals; Incidence; Individual; Intervention; Intervention Studies; Interview; Life; Measures; Medical; Medical Faculty; Mental Health; Modeling; Motivation; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Prevention; Prevention approach; Problem Solving; Public Health; Qualitative Methods; Randomized; Recording of previous events; Recruitment Activity; Regimen; Research; Research Personnel; Resources; Risk; Role; Russia; Sampling; Seeds; Sexual Transmission; Social Environment; Social Network; Social support; Testing; Trust; United States; Universities; Viral; Viral Load result; Wisconsin; Woman; antiretroviral therapy; base; comparison group; compliance behavior; condoms; coping; disorder prevention; experience; group intervention; improved; informant; innovation; interdisciplinary collaboration; intervention effect; medical appointment; medical schools; member; men; men who have sex with men; novel; novel strategies; peer; phase 1 study; phase 2 study; psychosocial; public health relevance; skills; social; therapy adherence; therapy design; tool; transmission process; treatment adherence; uptake

DESCRIPTION (provided by applicant): A large proportion of persons living with HIV infection (PLH) in Russia are not presently in HIV medical care and a majority of PLH on antiretroviral therapy (ART) do not adhere to their regimens at levels needed to achieve full viral suppression. This results in poor health outcomes. Because viral suppression reduces the likelihood of HIV transmission, poor care attendance and ART adherence also increase HIV disease incidence at a population level. This application proposes to expand a longstanding, bilateral, and interdisciplinary collaboration between investigators at the Center for AIDS Intervention Research (CAIR) at the Medical College of Wisconsin, USA and a scientific team at St. Petersburg State University Medical Faculty to develop and pilot test a novel intervention that harnesses peer social support to improve ART care engagement and adherence. In the first year qualitative phase, the scientific team will carry out and analyze data from in-depth interviews with approximately 60 PLH and key informants knowledgeable about the PLH community. The sample will include PLH in and out of medical care, selected to represent diverse exposure risks including drug users, men who have sex with men, and heterosexual PLH. The qualitative phase will identify individual-level, social, and structural factors responsibe for poor treatment attendance and adherence as well as resources that facilitate medical care, especially the role of social support. Phase II of the research will integrate qualitative findings into a peer social support intervention designed to improve care engagement and ART adherence. Our prior research has established that PLH in the community are often clustered in their friendship groups with other HIV+ persons and that these intact PLH friendship groups can be recruited into research. The intervention to be tested differs from traditional one-on-one adherence patient counseling by intervening with entire PLH friendship groups to create peer social and normative support for treatment. The test-of-concept pilot intervention will recruit 20 out-of-care or ART nonadherent seeds and also all willing HIV+ persons in each seed's personal friendship group (expected n=100 participants). Following baseline assessment of care engagement, ART adherence, psychosocial distress, substance use, and CD4+ and viral load, 10 of the PLH friend groups (n=50 participants) will be randomized to an intervention condition and 10 PLH friend groups (n=50) to the comparison condition. All members of each friendship group in the intervention condition will together attend a 7-session intervention that targets attitudes, intentions, and skills for entering, remaining, and adhering to HIV medical care. Because participants will attend sessions with other PLH who are their own friends in day-to-day life, all sessions will build and increase mutual social support within each friendship group for care and adherence. Intervention outcomes will be determined by baseline to 6-month followup change on behavioral and biological measures. If the intervention pilot test provides evidence of intervention benefit, we will later propose a larger scale trial of the approach.

描述（由申请人提供）：在俄罗斯，很大一部分艾滋病毒感染者（PLH）目前没有接受艾滋病毒医疗护理，并且大多数接受抗逆转录病毒治疗（ART）的艾滋病毒感染者没有坚持达到完全抑制病毒所需水平的治疗方案。这会导致健康状况不佳。由于病毒抑制降低了艾滋病毒传播的可能性，护理出勤率低和抗逆转录病毒治疗依从性也会增加人群中艾滋病毒的发病率。该申请旨在扩大美国威斯康星医学院艾滋病干预研究中心 (CAIR) 的研究人员与圣彼得堡州立大学医学院的科学团队之间的长期、双边和跨学科合作，以开发和试点测试一种新颖的干预措施，利用同伴社会支持来提高 ART 护理的参与度和依从性。在第一年的定性阶段，科学团队将对大约 60 名 PLH 和了解 PLH 社区的关键知情人进行深入访谈，并分析数据。该样本将包括医疗保健内外的 PLH，选择代表不同的暴露风险，包括吸毒者、男男性行为者和异性恋 PLH。定性阶段将确定导致治疗出勤率和依从性不佳的个人层面、社会和结构因素，以及促进医疗保健的资源，特别是社会支持的作用。研究的第二阶段将整合定性研究结果 旨在提高护理参与度和 ART 依从性的同伴社会支持干预措施。我们之前的研究表明，社区中的 PLH 通常聚集在与其他 HIV 感染者的友谊小组中，并且这些完整的 PLH 友谊小组可以被招募到研究中。待测试的干预措施与传统的一对一依从性患者咨询不同，它通过对整个 PLH 友谊小组进行干预，为治疗创造同伴社会和规范支持。概念测试试点干预措施将招募 20 个失养或未接受 ART 治疗的种子，以及每个种子个人友谊小组中所有自愿的艾滋病病毒感染者（预计参与者人数 = 100 人）。在对护理参与度、ART 依从性、社会心理困扰、物质使用以及 CD4+ 和病毒载量进行基线评估后，10 个 PLH 朋友组（n = 50 名参与者）将被随机分配到干预条件，10 个 PLH 朋友组（n = 50）分配到比较条件。处于干预条件下的每个友谊小组的所有成员将一起参加为期 7 次的干预，其目标是进入、继续和坚持艾滋病毒医疗护理的态度、意图和技能。因为参与者将与其他 PLH 一起参加会议，他们是他们日常生活中的朋友，所以所有会议都将在每个友谊小组内建立和增加相互的社会支持，以实现关怀和依从。干预结果将根据行为和生物学指标的基线至 6 个月随访变化来确定。如果干预试点测试提供了干预益处的证据，我们稍后将提议对该方法进行更大规模的试验。