Positive Connections: COPA2

积极的联系：COPA2

• 批准号: 9514502
• 负责人: Deborah Lynne Jones
• 金额: $ 15.18万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9514502
• 关键词: AIDS prevention; Adherence; Alcohol or Other Drugs use; Anti-Retroviral Agents; Argentina; Attitude; CD4 Lymphocyte Count; Caring; Cells; Central America; Clinic; Clinical; Clinical Trials; Communicable Diseases; Communication; Communities; Comprehensive Health Care; Consultations; Country; Diagnosis; Dose; Drops; Effectiveness; Eligibility Determination; Epidemic; Feasibility Studies; Government; HIV; HIV Infections; Health; Health Services Accessibility; Incidence; Individual; Intervention; Latin American; Letters; Link; Modeling; Motivation; Outcome Study; Patients; Pharmaceutical Preparations; Physician-Patient Relations; Physicians; Pilot Projects; Population; Positioning Attribute; Prevalence; Prevention; Privatization; Public Health; Randomized; Randomized Clinical Trials; Reporting; Risk Reduction; Self Efficacy; Services; Site; Societies; South America; Supervision; Testing; Training; Treatment Failure; Urban Population; Viral; Viral Load result; antiretroviral therapy; base; compliance behavior; cost; design; improved; innovation; medication compliance; motivational enhancement therapy; patient oriented; response; satisfaction; skills training; standard of care; therapy adherence; transmission process; trial design; viral resistance

Abstract. “Challenging” HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as retention in care is also associated with reduction in overall community-level viral burden. Linkage to care, early initiation of antiretroviral therapy (ART), adherence and retention in treatment enables HIV-infected individuals to achieve and maintain viral suppression to non-detectable levels, optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral (ARV) medication, which removed cost and access as barriers to care for HIV-infected patients. Yet, as in the USA, drop out occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 77,000 (70%) have been diagnosed and 60,000 (54%) were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. Our pilot study estimated retention in care ranged from 65-90%. Given universal access to care, patients with uncontrolled HIV constitute an urgent public health problem due to the increased likelihood of viral resistance, treatment failure and HIV transmission. To achieve meaningful reductions in HIV infection at the community level, new and innovative strategies must be developed to re-engage patients not retained in care. Motivational Interviewing (MI) is a widely used collaborative patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our recently completed pilot feasibility study targeted challenging patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. The pilot study, which utilized MI and was culturally tailored to the local setting, was feasible and acceptable to patients, physicians and clinic staff. Results demonstrated that a physician-based MI intervention was effective in re-engaging patients in care, i.e., enhanced and sustained patient adherence, viral suppression and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline. The proposed clinical trial seeks to extend these findings in public and private clinics in 4 urban population centers in Argentina, in which clinics (N = 6 clinics, 6 MDs per site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the proposed study will test the effectiveness of a physician-based Motivational Interviewing intervention to improve and sustain retention, adherence, persistence and viral suppression among “challenging” patients (n = 360) over 24 months. Results will have important public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence.

抽象的。 “具有挑战性”的艾滋病毒感染者，即那些没有继续接受治疗的患者，是治疗的关键焦点 积极预防，因为保留护理也与社区层面病毒总体减少有关 负担。与护理的联系、早期开始抗逆转录病毒治疗 (ART)、坚持和保留治疗 使艾滋病毒感染者能够实现并维持病毒抑制至不可检测的水平，优化 健康和减少艾滋病毒传播。阿根廷是最早提供担保的拉丁美洲国家之一 HIV 预防、诊断和综合护理服务，包括抗逆转录病毒 (ARV) 药物， 消除了治疗艾滋病毒感染者的成本和获取障碍。然而，就像在美国一样，辍学发生在 HIV 连续体的每个阶段。阿根廷估计有 110,000 人感染艾滋病毒；其中， 77,000 人（70%）已被确诊，60,000 人（54%）需要接受治疗。然而，只有 36% 的人实现了 病毒受到抑制，31% 的确诊患者延迟接受治疗。我们的试点研究估计保留率 护理范围为 65-90%。鉴于普遍获得护理服务，艾滋病毒不受控制的患者已成为一个紧迫的问题 由于病毒耐药性、治疗失败和艾滋病毒的可能性增加而导致的公共卫生问题 传播。为了在社区一级实现艾滋病毒感染的有意义的减少，新的和创新的 必须制定策略来重新吸引未接受护理的患者。 动机访谈 (MI) 是一种广泛使用的以患者为中心的协作方法，并且已被用于 由中美洲和南美洲的治疗师进行，以增强对药物使用和风险的动力和承诺 减少。我们最近完成的试点可行性研究针对的是未接受治疗的挑战性患者 在阿根廷布宜诺斯艾利斯的公立和私人诊所。该试点研究利用了 MI 并在文化上 根据当地情况量身定制，对于患者、医生和诊所工作人员来说是可行且可接受的。结果 证明基于医生的 MI 干预可以有效地让患者重新接受护理，即 增强和持续的患者依从性、病毒抑制和医患沟通 基线后 6 个月和 9 个月时这些患者对治疗的态度。 拟议的临床试验旨在将这些发现扩展到 4 个城市人口的公立和私人诊所 阿根廷的中心，其中诊所（N = 6 个诊所，每个地点 6 位医学博士）被随机分配到实验组（医生 MI 干预）（n = 3）或对照（医生护理标准）（n = 3）条件，比例为 3:3。使用集群 随机临床试验设计，拟议的研究将测试基于医生的动机的有效性 访谈干预以改善和维持保留、依从性、持久性和病毒抑制 24 个月内“具有挑战性”的患者 (n = 360) 中。结果将对公共卫生产生重要影响 实施 MI 以使患者重新参与并保留艾滋病毒治疗和护理，并改善病毒感染 通过高水平的药物依从性进行抑制。