Technology Based Community Health Nursing to Improve cART Adherence and Virologic Suppression in Youth Living with HIV (TechN 2 CheckIN): A Regional Multi-site Study

基于技术的社区健康护理可提高青少年 HIV 感染者的 cART 依从性和病毒学抑制 (TechN 2 CheckIN)：一项区域多中心研究

• 批准号: 9395467
• 负责人: ALLISON L AGWU
• 金额: $ 84.58万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-02 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9395467
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Affect; Age; Area; Baltimore; Behavior; Behavioral; Caregivers; Caring; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chlamydia trachomatis; Chronic Disease; Clinic; Clinical; Clinical assessments; Communication; Communities; Community Health Nurse Specialist; Community Health Nursing; Complex; Continuity of Patient Care; Control Groups; Data; Deterioration; Development; Diagnosis; Disease Progression; Distal; Drug resistance; Enhancement Technology; Enrollment; Evidence based intervention; Evolution; Face; Failure; Family; Goals; HIV; HIV Infections; HIV diagnosis; Health; Healthcare Systems; Hospitalization; Immunologics; Incidence; Individual; Infection; International; Intervention; Intervention Studies; Life Expectancy; Low income; Maintenance; Medical; Medical Care Team; Modality; Modeling; Monitor; Nature; Neisseria gonorrhoeae; Nursing Services; Outcome; Outpatients; Ownership; Parents; Patients; Pelvic Inflammatory Disease; Pharmaceutical Preparations; Pharmacy facility; Protocols documentation; Provider; Public Health; Randomized; Randomized Controlled Trials; Recurrence; Research; Resources; Risk; Risk Behaviors; Self Care; Services; Sexually Transmitted Diseases; Site; Social isolation; Socioeconomic Status; Solid; Technology; United Nations; United States; United States National Institutes of Health; Viremia; Visit; Wages; Washington; Woman; Work; Youth; antiretroviral therapy; arm; base; clinical care; cognitive development; compare effectiveness; cost; cost effective; cost effectiveness; disease transmission; disorder prevention; disorder risk; effective therapy; ethnic minority population; follow-up; health care service utilization; high risk; improved; improved outcome; innovation; mHealth; medication compliance; meetings; metropolitan; minority communities; named group; novel; novel strategies; nursing intervention; outreach; premature; prevent; psychosocial; racial and ethnic; racial and ethnic disparities; randomized trial; retention rate; standard of care; therapy adherence; therapy design; transmission process; treatment adherence; trial design; virology; young adult; young man; young men who have sex with men

Human immunodeficiency virus (HIV) infection has disproportionately persisted as a public health threat to adolescents and young adults (AYA) from minority communities in the United States. HIV has evolved into a chronic disease, which can be managed in the outpatient setting with antiretroviral therapy (ART) designed to achieve virologic suppression and life expectancy equivalent for uninfected individuals. However, for AYA, huge disparities exist compared to adults, with greater proportions unaware of their status, lower rates of care engagement, retention, and initiation and maintenance of ART, resulting in higher rates of virologic non- suppression, and development of sequelae including immunologic deterioration and transmission. Interventions designed to improve outcomes for youth living with HIV (YLHIV) are being sponsored by agencies including the Centers for Disease Control and Prevention and the National Institutes of Health, however, most target the early components of the continuum of care (identification, linkage, and ART initiation). Our research from the HIV Research Network shows that 30-40% of YLHIV are not virologically suppressed despite being in care, highlighting the need for novel interventions targeting the distal components of the care continuum. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources, enhance health care utilization, and promote risk-reducing behavior among AYA. Use of short messaging service (SMS) messaging can further enhance clinical care by improving attendance at medical visits, medication adherence, and communication with the health care team. We have used these two modalities in randomized trials of youth with complex sexually transmitted infections (STIs) in low-income minority communities with high feasibility and acceptability amongst AYA and their families, remarkable improvements in visit completion, medication adherence, and reduction in recurrent STIs. The overarching goal of this project is to build on the evidence from this trial and to repurpose the intervention for YLHIV in the same community who are having challenges with care and medication non-adherence. We aim to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N 2 CHECK-IN) to a standard of care control group using a randomized trial design. The central hypothesis is that the intervention will result in higher rates of adherence to ART and virologic suppression. We have demonstrated our interdisciplinary team's capacity to follow urban AYA in the community, utilizing the combination of CHNs and outreach workers to optimize care according to national standards. TECH-IN 2 CHECK-IN aims to enroll 120 YLHIV followed at clinics specializing in HIV care in the Baltimore-Washington Metropolitan area who are challenged with treatment adherence and randomizing them to receive TECH-IN 2 CHECK-IN vs. standard of care. Results of this trial will inform best practices for engaging YLHIV by addressing the distal component of the continuum, critical to achieving the elusive 90-90-90 HIV goals.

人类免疫缺陷病毒 (HIV) 感染一直不成比例地持续存在，对人类健康构成威胁 来自美国少数族裔社区的青少年和年轻人 (AYA)。艾滋病毒已演变为 慢性疾病，可以在门诊通过抗逆转录病毒疗法（ART）进行治疗，旨在 实现未感染个体的病毒学抑制和等效预期寿命。然而对于AYA来说， 与成年人相比，存在巨大差异，更大比例的人不知道自己的状况，护理率较低 ART 的参与、保留、启动和维持，导致病毒学非病毒感染率更高 抑制和后遗症的发展，包括免疫恶化和传播。 旨在改善感染艾滋病毒的青少年 (YLHIV) 的干预措施由 疾病控制与预防中心和国立卫生研究院等机构， 然而，大多数针对连续护理的早期组成部分（识别、联系和 ART 引发）。我们来自 HIV 研究网络的研究表明，30-40% 的 YLHIV 没有病毒学特征 尽管在护理中但仍受到抑制，强调需要针对远端部件进行新的干预措施 护理连续体。社区卫生护士 (CHN) 的干预措施已被证明可以增加获得服务的机会 适当的资源，提高医疗保健利用率，并促进 AYA 中降低风险的行为。使用 短信服务 (SMS) 消息传递可以通过提高就诊率来进一步增强临床护理 就诊、服药依从性以及与医疗团队的沟通。这两个我们都用过 对低收入患有复杂性传播感染 (STI) 的青少年进行的随机试验的模式 少数族裔社区在 AYA 及其家人中具有较高的可行性和接受度，引人注目 改善就诊完成率、药物依从性和减少复发性传播感染。首要的 该项目的目标是以本次试验的证据为基础，重新调整针对 YLHIV 的干预措施 同一社区面临护理和不依从药物治疗的挑战。我们的目的是比较 技术增强型社区健康护理干预（TECH-N 2 CHECK-IN）的有效性 使用随机试验设计的护理标准对照组。中心假设是干预 将导致更高的 ART 和病毒学抑制依从率。我们已经展示了我们的 跨学科团队在社区中遵循城市 AYA 的能力，利用 CHN 和 外展工作人员根据国家标准优化护理。 TECH-IN 2 CHECK-IN 旨在招收 120 名 YLHIV 在巴尔的摩-华盛顿都市区专门从事艾滋病毒护理的诊所进行了跟踪，这些诊所是 挑战治疗依从性，并随机将他们接受 TECH-IN 2 CHECK-IN 与标准 关心。该试验的结果将为通过解决 YLHIV 的远端部分来参与 YLHIV 的最佳实践提供信息。 这个连续体对于实现难以捉摸的 90-90-90 艾滋病毒目标至关重要。