Supporting Sustained HIVTreatment Adherence after Initiation (SUSTAIN)

项目摘要 在全球范围内，抗逆转录病毒治疗(ART)依从性和滞留率低于最佳水平是导致 持续的艾滋病毒传播、治疗失败、疾病和死亡。艾滋病毒专家一致认为，为了改善抗逆转录病毒治疗的结果 临床护理系统必须做两件关键的事情：(1)发现不依从者(识别活着的不依从者 尽早感染艾滋病毒(PLWH)；和(2)支持良好遵守(实施有效的干预措施以 促进更好地保留和坚持艺术)。可持续发展研究将通过以下方式追求这两个目标 五种基于证据的早期不依从性检测和依从性支持组合的最佳组合 南非开普敦当地诊所的护士。在这五个组件中，有三个侧重于寻找非 坚持：(1)当标准检测显示病毒未被抑制时，立即与患者接触；(2) 药房再灌装监测(PRM)和随访；以及(3)实时电子依从性监测(EAM)。二 组成部分侧重于通过加强开普敦现有的患者支持来支持良好的依从性：(4) 使用激励性面谈技术和(5)每周签到应用增强的同龄人小组支持 短信。每个组件都是可行、可接受和有效的，可用于监测或支持PLWH的遵从性 在开普敦或类似的低资源环境中。在自决理论的启发下，每个人都在 行为调解人，可以增加动机和能力，并提高艺术坚持性和 留存。为了确定组件的最佳组合，我们将利用创新和实用的应用程序 多阶段优化策略(MOST)，这是一种以工程为灵感的方法，特别适合于 测试单独的干预组件及其组合中的交互作用，以“优化”有效的多个 组件干预。在MOST的指导下，我们提出了三个具体目标：(1)使用有效的分数 用析因设计确定五种干预因素对HIV病毒抑制的影响 次要结果；(2)评估干预组件以解决实施、服务和客户问题 根据普罗科特框架的结果；以及(3)使用有效性、成本和执行数据 从目标1和目标2开始，对成本效益优化的多组件干预进行建模，并实施- 国庆成功。维持性解决了NIH的一个关键优先事项-加强对高危PLWH的护理 治疗失败。这也将是第一批使用最多的研究之一，以改善艾滋病毒护理的连续性 资源受限设置。这项研究结合了不同的方法来发现不粘连和 支持良好的遵从性具有很高的潜力，可以确定具有成本效益和可扩展的基于证据的 预防和改善艾滋病毒的治疗结果。包括实时电子监控和药房 作为干预组件的再灌装监测将增加对技术最佳使用的理解 支持坚持。重要的是，我们的方法可以用作其他设置的模板，以识别和 实施最适当和最有效的循证干预措施，以产生广泛的、具有成本效益的影响。

Project Summary Globally, suboptimal levels of antiretroviral treatment (ART) adherence and retention are major causes of ongoing HIV transmission, treatment failure, illness, and death. To improve ART outcomes, HIV experts agree that clinical care systems must do two key things: (1) Find nonadherence (identify nonadherent people living with HIV (PLWH) as early as possible); and (2) Support good adherence (implement effective interventions to promote better ART retention and adherence). The SUSTAIN study will pursue both objectives by determining the optimal combination of five evidence-based early nonadherence detection and adherence support compo- nents in local clinics in Cape Town, South Africa. Of these five components, three focus on finding non- adherence: (1) immediate outreach to the patient when standard testing shows unsuppressed virus; (2) pharmacy refill monitoring (PRM) and follow-up; and (3) real-time electronic adherence monitoring (EAM). Two components focus on supporting good adherence by strengthening existing patient support in Cape Town: (4) applying enhanced peer group support using motivational interviewing techniques and (5) weekly check-in texts. Each component is feasible, acceptable, and effective for monitoring or supporting adherence in PLWH in Cape Town or a similar low-resource setting. As informed by Self-Determination Theory, each addresses behavioral mediators that can increase motivation and competence and improve ART adherence and retention. To identify the best combination of components, we will utilize an innovative and practical application of Multiphase Optimization STrategy (MOST), an engineering-inspired approach that is uniquely suited to the testing of separate intervention components and their interactions in combinations to “optimize” a potent multi- component intervention. Guided by MOST, we propose three specific aims: (1) employ an efficient fractional factorial design to determine the effects of five intervention elements on HIV viral suppression, as well as secondary outcomes; (2) evaluate intervention components to address implementation, service, and client outcomes according to the Proctor framework; and (3) use the effectiveness, cost, and implementation data from Aims 1 and 2 to model the multi-component intervention optimized for cost-effectiveness and implement- ation success. SUSTAIN addresses a crucial NIH priority—strengthening care for PLWH at high risk of treatment failure. It will also be among the first studies to use MOST to improve the HIV care continuum in a resource-constrained setting. The study’s combination of different methods of finding nonadherence and supporting good adherence has high potential to identify cost-effective and scaleable evidence-based inter- ventions and improve HIV treatment outcomes. Inclusion of both real-time electronic monitoring and pharmacy refill monitoring as intervention components will increase understanding of the best uses of technology to support adherence. Importantly, our approach can be used as a template for other settings to identify and implement the most appropriate and effective evidence-based interventions for broad, cost-effective impact.