Adapting an effective intervention for enhancing engagement in HIV care to meet the needs of key populations in India

采取有效的干预措施，加强艾滋病毒护理的参与，以满足印度重点人群的需求

• 批准号: 10676961
• 负责人: Maria L. Ekstrand
• 金额: $ 36.36万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676961
• 关键词: Address; Adherence; Adoption; Affect; Appointment; Awareness; Behavior; Caring; Clinic Visits; Collaborations; Communities; Consumption; Continuity of Patient Care; Counseling; Data; Disclosure; Disparity; Drops; Educational workshop; Eligibility Determination; Ensure; Environment; Feedback; Fright; Future; General Population; Government; HIV; Health; High Prevalence; India; Intervention; Interview; Interviewer; Lead; Learning; Legal; Link; Mainstreaming; Manuals; Medical; Medical center; Mental Depression; Modeling; Modification; Newly Diagnosed; Outcome; Pamphlets; Participant; Persons; Pharmaceutical Preparations; Policies; Population; Positioning Attribute; Prevalence; Preventive; Procedures; Process; Professional counselor; Quality of life; Questionnaires; Randomized; Randomized, Controlled Trials; Recommendation; Recording of previous events; Regimen; Reporting; Research; Resources; Schedule; Services; Sexual Partners; South Africa; Stress; Testing; Time; Trust; Viral; Viral Load result; Virus Replication; Wellness Program; Work; acceptability and feasibility; antiretroviral therapy; arm; attentional control; barrier to care; care seeking; community engagement; cost; effective intervention; experience; feasibility trial; flexibility; improved; intervention participants; medication compliance; member; men who have sex with men; minority stress; navigator intervention; operation; patient engagement; peer; perceived discrimination; pilot test; pilot trial; preference; programs; sexual minority; social stigma; theories; therapy adherence; transgender women; transmission process; trial design; viral transmission; virtual

PROJECT SUMMARY/ ABSTRACT Progress toward UNAIDS testing and treatment targets has been slow in many global settings, including India, where only 46% of the 2.1 million people who live with HIV (PLWH) are estimated to be virally suppressed. This gap is especially pronounced among Key Populations (KP) who have much higher prevalence of HIV than the general population, but lower rates of viral suppression, partly due to intersecting stigma. In this application, we therefore seek to adapt and pilot test a comprehensive wellness program to address the barriers to engagement in the HIV care continuum among men who have sex with men (MSM) and transgender women (TGW) in India. The proposed adapted intervention is guided by a conceptual model that integrates our India-specific HIV stigma model, which showed that stigma can delay care-seeking both directly and indirectly, with the Minority Stress Model adapted for India by our Indian collaborator. The content involves an adaptation of our earlier Chetana wellness adherence intervention which was found to successfully improve adherence and viral suppression among mainstream Indian PLWH. Based on our initial formative work, the adaptation includes added wellness group content and will be offered in a flexible format. It also uses peer navigators (PN), rather than MA-level counselors, to deliver tailored support at mutually convenient times and places. This PN model has been used successfully by our Indian collaborators and in our previous research in South Africa to link and retain PLWH in care. The intervention is intended to break the link between stigma and care seeking, which is especially important for KPs, who must deal with historically hostile legal environments and substantial isolation that further reduces engagement in HIV preventive practices and services. This application also takes advantage of India’s adoption of a universal test-and-treat policy, allowing newly diagnosed KPs to be immediately engaged in HIV care, rather than having to wait until they meet CD4 eligibility criteria. Our Indo-US team has a long history of prior research collaborations as well as more than 20 years of work with key populations in this setting. We are thus uniquely positioned to conduct the proposed research to address the following aims: 1) To engage community stakeholders in the adaptation and pilot testing of the Chetana-PN wellness adherence intervention for use with Indian MSM and TGW who are living with HIV and who are newly or insufficiently engaged in care. 2a) To assess in a small RCT the acceptability and feasibility of the theoretically-guided, adapted intervention and to obtain preliminary effect size estimations for the impact of the intervention on engagement in care, among MSM and TGW. 2b) To characterize participant and navigator experiences in the Chetana-PN intervention and describe the practices that were most successful at overcoming barriers to care with 25 participants who received the Chetana-PN intervention and the peer navigators. These findings will subsequently be used to inform a future RCT designed to establish the efficacy of this adapted Chetana-PN intervention for sexual minorities in India.

项目概要/摘要 在包括印度在内的许多全球环境中，联合国艾滋病规划署的检测和治疗目标进展缓慢 据估计，210 万艾滋病毒感染者 (PLWH) 中只有 46% 的病毒受到抑制。 这一差距在关键人群 (KP) 中尤为明显，他们的艾滋病毒感染率比其他人群高得多。 普通人群，但病毒抑制率较低，部分原因是交叉耻辱。在这个 因此，我们寻求调整和试点测试全面的健康计划，以解决 男男性行为者 (MSM) 参与艾滋病毒护理连续性的障碍，以及 印度的跨性别女性（TGW）。拟议的适应性干预措施以概念模型为指导，该模型 整合了我们印度特有的艾滋病毒耻辱模型，该模型表明耻辱可以直接延迟就医 间接地，我们的印度合作者针对印度采用了少数民族压力模型。内容 涉及对我们早期 Chetana 健康依从性干预措施的改编，该干预措施被发现成功 提高印度主流感染者的依从性和病毒抑制。根据我们最初的形成 工作中，改编包括添加的健康小组内容，并将以灵活的形式提供。它还使用 同行导航员 (PN)，而不是 MA 级别的辅导员，在双方方便的时间提供量身定制的支持 和地方。这个 PN 模型已被我们的印度合作者以及我们之前的合作者成功使用 南非开展了一项旨在将艾滋病毒感染者联系起来并将其保留在护理中的研究。干预的目的是打破两者之间的联系 耻辱和寻求护理，这对于必须应对历史上敌对法律的 KP 来说尤其重要 环境和实质性隔离进一步减少了对艾滋病毒预防实践的参与， 服务。该应用程序还利用了印度采用的通用测试和治疗政策，允许 新诊断的 KP 应立即参与 HIV 护理，而不必等到遇到 CD4 资格标准。我们的印度-美国团队拥有悠久的先前研究合作历史以及 20 多个 在这种情况下与重点人群进行了多年的合作。因此，我们处于独特的地位来进行拟议的 研究旨在实现以下目标： 1) 让社区利益相关者参与适应和试点 测试 Chetana-PN 健康依从性干预措施，用于在世的印度 MSM 和 TGW 感染艾滋病毒以及刚刚或未充分参与护理的人。 2a) 在小型随机对照试验中评估可接受性 理论指导、适应性干预的可行性，并获得初步效果大小估计 干预措施对 MSM 和 TGW 参与护理的影响。 2b) 表征 参与者和导航员在 Chetana-PN 干预中的经验，并描述了所采取的做法 接受 Chetana-PN 干预的 25 名参与者在克服护理障碍方面最为成功 和同行导航员。这些发现随后将用于为未来的随机对照试验提供信息，该随机对照试验旨在建立 这种经过调整的 Chetana-PN 干预措施对印度性少数群体的功效。