Mopati: A Pilot HIV Treatment Partner Intervention in Botswana

项目摘要：博茨瓦纳的艾滋病毒流行率位居世界第二。低成本、可扩展 干预措施对于支持艾滋病毒携带者坚持抗逆转录病毒治疗(ART)和 请继续看护。其中一种干预措施是使用艾滋病毒推荐的治疗伙伴 全球至少20个国家的治疗指南。具体地说，几个国家的国家艾滋病毒政策， 包括博茨瓦纳在内，建议医疗保健提供者鼓励患者发起抗逆转录病毒治疗，以识别 可以提供支持、陪同患者预约并提供用药提醒的个人。 尽管大量工作表明社会支持在促进遵守方面的关键作用，但关于 治疗伙伴的有效性显示出好坏参半的结果。因此，需要进行研究来确定如何 可以更好地利用来自治疗伙伴的支持。我们的R21研究考察了 治疗伙伴。结果表明，有效的治疗伙伴不仅有助于坚持治疗，而且 提供基本的非医疗支持(例如，运输、食品准备)，并确保有效的治疗伙伴 与其他类型的网络成员相比，更有可能是配偶或其他亲密伴侣。治疗 伴侣，特别是不受压抑患者的伴侣，要求接受咨询技能培训。以我们的R21为基础， 我们建议试行Mopati计划的效果(官方语言茨瓦纳语中的“合作伙伴” 博茨瓦纳)，这是一个多层次的干预措施，引导医疗保健提供者和患者了解治疗伙伴 选择，并就提供有效支持对治疗伙伴进行培训。具体目标是：(1)发展 多层次治疗合作伙伴干预，社区和医疗保健提供者利益相关者提供意见 博茨瓦纳；以及(2)对病毒的可行性、可接受性和初步效果进行初步测试 抑制多层次治疗伙伴的干预。我们将招募80名非艾滋病病毒携带者 病毒抑制和他们的80个治疗伙伴在2个配对的诊所对(总共4个诊所；20个二联体/诊所) 博茨瓦纳哈博罗内。诊所将被随机分配到标准护理或医疗保健提供者指导 和治疗伙伴培训干预(即，所有诊所提供者都接受有关建议患者的培训 选择治疗伙伴，所有治疗伙伴接受关于艾滋病毒治疗的教育和培训 以非对抗性、非评判性的方式为患者提供咨询)。我们将调查患者和治疗情况 合作伙伴在基线和基线后6个月收集临床记录中的病毒载量。干预 可行性和可接受性将通过混合方法进行评估(例如，对患者的半结构化访谈， 治疗伙伴和诊所工作人员；拒绝率)。我们将把结果提交给制定 博茨瓦纳国家艾滋病毒和艾滋病治疗指南。这项研究提供了一个独特的机会来 研究如何在各国的实践中改进抗逆转录病毒药物的使用，并对艾滋病毒护理也具有相关性 作为需要严格遵守的其他疾病(如糖尿病、结核病)的医疗保健。

PROJECT SUMMARY: Botswana has the second-highest HIV prevalence in the world. Low-cost, scalable interventions are essential to support people living with HIV to adhere to antiretroviral treatment (ART) and remain in care. One such intervention is the use of treatment partners, which are recommended by HIV treatment guidelines in at least 20 countries worldwide. Specifically, national HIV policies of several countries, including Botswana, recommend that healthcare providers encourage patients initiating ART to identify an individual who can provide support, accompany patients to appointments, and provide medication reminders. Although a large body of work indicates the key role of social support in promoting adherence, research on treatment partners' effectiveness has shown mixed results. Thus, research is needed to determine how support from treatment partners can be better harnessed. Our R21 study examined optimal characteristics of treatment partners. Results indicated that effective treatment partners not only help with adherence, but also provide essential non-medical support (e.g., transport, food preparation), and that effective treatment partners are more likely to be spouses or other intimate partners than other types of network members. Treatment partners, especially of unsuppressed patients, requested counseling skills training. Using our R21 as a basis, we propose to pilot test the effects of the Mopati program (“partner” in Setswana, the official language of Botswana), a multi-level intervention that guides healthcare providers and patients about treatment partner selection, and trains treatment partners on provision of effective support. The Specific Aims are: (1) To develop a multi-level treatment partner intervention with input from community and healthcare provider stakeholders in Botswana; and (2) To conduct a pilot test of the feasibility, acceptability, and preliminary effects on viral suppression of a multi-level treatment partner intervention. We will recruit 80 people living with HIV who are not virally suppressed and their 80 treatment partners in 2 matched clinic pairs (4 clinics total; 20 dyads/clinic) in Gaborone, Botswana. Clinics will be randomly assigned to standard of care or a healthcare provider guidance and treatment partner training intervention (i.e., all clinic providers receive training on advising patients about treatment partner selection, and all treatment partners receive HIV treatment education and training on counseling patients using a non-confrontational, non-judgmental style). We will survey patients and treatment partners at baseline and 6-months post-baseline and collect viral load from clinic records. Intervention feasibility and acceptability will be assessed via mixed methods (e.g., semi-structured interviews with patients, treatment partners, and clinic staff; refusal rates). We will present results to the committee that develops the Botswana National HIV and AIDS Treatment Guidelines. This research presents a unique opportunity to examine ways to improve ART use in practice across countries and has relevance for both HIV- care as well as healthcare for other conditions (e.g., diabetes, tuberculosis) that require strict adherence.