Promoting Viral Suppression through the CHAMPS+ Intervention in the Deep South

通过 CHAMPS 干预南部腹地促进病毒抑制

• 批准号: 10819823
• 负责人: David S Batey
• 金额: $ 116.05万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-21 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10819823
• 关键词: Address; Adherence; Adult; Alabama; Anti-Retroviral Agents; Area; Black Populations; Caring; Cessation of life; Chronic; Clinic; Clinical assessments; Clinical effectiveness; Communities; Community Health Aides; Complex; Continuity of Patient Care; Counseling; Country; Data; Deep South; Development; Diagnosis; Disease; Disparity; Epidemic; Evaluation; Focus Groups; General Population; Geographic Locations; Geography; HIV; HIV Infections; HIV risk; HIV/AIDS; Health; Health Services Accessibility; Health Technology; Healthcare; Healthcare Systems; Human Resources; Human immunodeficiency virus test; Individual; Intervention; Intervention Trial; Life Expectancy; Literature; Location; Louisiana; Manuals; Medical; Mississippi; Mobile Health Application; Modeling; New York City; Outcome; Patient Monitoring; Persons; Population; Principal Investigator; Public Health; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Regimen; Research; Research Design; Resources; Risk; Risk Behaviors; Risk Reduction; Rural; Sampling; Self Management; Services; Sex Behavior; Target Populations; Testing; Therapeutic; Time; Translations; Treatment Protocols; United States; Viral; Viral Load result; Work; antiretroviral therapy; clinical efficacy; community organizations; effectiveness evaluation; epidemic preparedness; ethnic minority; evidence base; experience; future implementation; health disparity; health disparity populations; health literacy; implementation determinants; improved; innovation; mHealth; marginalized population; medication compliance; men who have sex with men; multi-component intervention; premature; prevent; primary outcome; racial minority; recruit; resistance mutation; response; retention rate; scale up; secondary outcome; social; standard of care; substance use; success; therapy adherence; transgender women; transmission process

Despite efforts to achieve UNAIDS 95-95-95 targets, marked deficits remain in HIV testing, antiretroviral therapy (ART) adherence, and viral suppression (VS) among a growing number of persons with HIV (PWH). Gaps in HIV treatment success are particularly pronounced in the United States (US) Deep South. These suboptimal HIV health outcomes occur at a time when clinicians have limited time and the US healthcare system remains fragmented, further exacerbating the challenges inherent in the lives of underserved, marginalized groups, such as PWH. In this way, the development and evaluation of interventions using a resource-savvy cadre of community health workers (CHW) holds promise for addressing these challenges. Yet, gaps exist in the CHW literature, and research is needed to bring CHW interventions to scale to ameliorate the large gaps in the US HIV Care Continuum, particularly in Ending the HIV Epidemic (EHE) priority locations. In response, our highly experienced study team has developed and tested the Community Health Workers And MHealth to ImProve Viral Suppression (CHAMPS) intervention which leverages mobile health (mHealth) technology to create a multi-component intervention that targets multiple levels (individual, social and sexual networks, and community) to improve ART adherence and VS. We propose to build on our strong preliminary data of extant intervention work in PWH and directly respond to RFA-MD-23-007 by leveraging our CHAMPS intervention which will be delivered by personnel from four HIV care settings in the Deep South. The CHAMPS+ intervention is delivered via an mHealth platform to support PWH to self-manage their ART regimens and adds to the extant CHAMPS intervention by adding a CHW-delivered supportive risk reduction counseling (sexual behavior and substance use) during periods of non-suppression to prevent HIV transmission. This proposed study also builds upon our mChoice (U01PS005229) and WiseApp (R01HS025071) studies to improve ART adherence and VS in the Deep South. The proposed study design has a three-fold purpose of: 1) engaging the target population in the development of culturally relevant recruitment materials and retention strategies for the proposed study, 2) assessing the clinical effectiveness and sustainability of the intervention in Deep South settings, and 3) evaluating regionalized implementation factors guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Ultimately, this study will test CHAMPS+ to promote ART adherence and suppressed viral load for PWH in in Alabama, Louisiana (Orleans Parish), and Mississippi, US EHE prioritized jurisdictions. Importantly, our multi- component intervention targets multiple levels to address HIV risk behaviors during periods of non- suppression--an innovative and impactful component likely to be of great public health import.

尽管为实现艾滋病规划署1995 - 1995 - 1995年的目标作出了努力， 在越来越多的艾滋病毒感染者（PWH）中，抗逆转录病毒疗法（ART）的依从性和病毒抑制（VS）。 艾滋病毒治疗成功的差距在美国（美国）南部腹地尤为明显。这些 当临床医生的时间有限，美国医疗保健机构 系统仍然支离破碎，进一步加剧了服务不足者生活中固有的挑战， 边缘化群体，如PWH。这样，使用一个 社区卫生工作者（CHW）的精通资源的干部为应对这些挑战带来了希望。 然而，CHW文献中存在空白，需要进行研究，以使CHW干预措施规模化， 改善美国艾滋病毒护理连续体的巨大差距，特别是在结束艾滋病毒流行（EHE）方面 优先位置。作为回应，我们经验丰富的研究团队开发并测试了社区 卫生工作者和MHealth改进利用移动的的病毒抑制（CHAMPS）干预 健康（mHealth）技术，以创建针对多个层面（个人， 社会和性网络，以及社区），以提高ART依从性和VS。我们建议建立在我们的 PWH现有干预工作的有力初步数据，并直接响应RFA-MD-23-007， 利用我们的CHAMPS干预措施，该干预措施将由来自四个艾滋病毒护理机构的人员提供， 南方腹地。CHAMPS+干预措施通过移动健康平台提供，以支持威尔斯亲王医院自我管理 他们的ART方案，并通过增加CHW提供的支持性风险来增加现有的CHAMPS干预 在非抑制期减少咨询（性行为和物质使用），以预防艾滋病毒 传输本拟定研究还基于我们的mChoice（U 01 PS 005229）和WiseApp （R 01 HS 025071）研究，以改善南方腹地的ART依从性和VS。拟定研究设计 有三重目的：1）让目标人群参与文化相关的发展， 拟定研究的招募材料和保留策略，2）评估临床有效性 和可持续性的干预，在深南设置，和3）评估区域化的实施 影响、有效性、采用、实施和维护框架指导下的因素。 最终，这项研究将测试CHAMPS+在促进PWH患者的ART依从性和抑制病毒载量方面的作用。 亚拉巴马、路易斯安那（奥尔良教区）和密西西比、美国EHE优先管辖区。重要的是，我们的多... 成分干预针对多个层次，以解决非艾滋病期间的艾滋病毒风险行为， 抑制-一个创新和有影响力的组成部分，可能具有重大的公共卫生意义。