Testing a Multi-Component Intervention to Improve Health Outcomes and Quality of Life among Rural Older Adults Living with HIV

测试多成分干预措施以改善农村艾滋病毒感染者的健康状况和生活质量

• 批准号: 10246599
• 负责人: ANDREW E PETROLL
• 金额: $ 50.89万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-08 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10246599
• 关键词: Address; Adherence; Advertisements; Age; Aging; Americas; Anti-Retroviral Agents; Baseline Surveys; Blood; Caring; Case Management; Collection; Communities; Complex; Dependence; Diagnosis; Discrimination; Elderly; Enrollment; Epidemic; Evidence based intervention; Face; Food; Formal caregiver; Goals; HIV; HIV diagnosis; Health; Healthcare Systems; Housing; Individual; Insurance; Intervention; Interview; Logistics; Mediator of activation protein; Medical; Mental Health; Morbidity - disease rate; Motivation; Newly Diagnosed; Outcome; Participant; Personal Satisfaction; Persons; Pharmaceutical Preparations; Population; Professional counselor; Provider; Quality of life; Randomized; Research; Resources; Risk; Rural; Rural Health; Sampling; Self Efficacy; Services; Social isolation; Social support; Spottings; Structure; Surveys; Technology; Telephone; Testing; Transportation; Viral; Viral Load result; Work; antiretroviral therapy; barrier to care; base; cognitive ability; comorbidity; depressive symptoms; design; eHealth; follow-up; health disparity; health related quality of life; improved; informal caregiver; innovation; intervention cost; literacy; medication compliance; mortality; multi-component intervention; multiphase optimization strategy; peer; primary outcome; recruit; rural area; rural counties; rural dwellers; rural environment; rural residence; rural setting; secondary outcome; social; social stigma; success; tool; transmission process

More than 55,000 people living with HIV (PLH) in the US live in rural areas, and more than 2,300 rural residents are diagnosed with HIV each year. PLH who live in rural areas have higher mortality rates compared with non-rural PLH. Rural PLH are diagnosed with HIV at a more advanced stage than non-rural individuals and present for medical care later, making them more likely to face comorbidities and need complex medical care. Rural PLH are also less likely than their urban counterparts to remain engaged in HIV care and to be virally suppressed. Compared with younger PLH, older PLH may face additional challenges to maintaining their health and wellbeing, and older PLH who also live in rural areas face the doubly challenging prospect of maintaining adherence to HIV care and managing medical conditions while living in a rural environment. Few interventions aimed at increasing VL suppression and improving health-related quality of life (HRQOL) exist for rural older PLH. Our previous qualitative and survey research with rural older PLH nationwide (N = 476) identified low social support, HIV-related stigma, lack of technology access, and structural barriers (such as difficulties with housing, food, transportation, and insurance) as key predictors of engagement in HIV care, viral load (VL) suppression, and HRQOL for this population. Based on this work, we propose developing an optimized intervention for rural older PLH using the multiphase optimization strategy (MOST). We will evaluate four intervention components, adapted from evidence-based interventions and delivered remotely: (1) counselor-facilitated peer social support, (2) HIV stigma reduction, (3) strengths-based case management, and (4) individually-tailored technology use optimization. We will recruit 400 rural older PLH nationwide through partnerships with community agencies and online advertisements, with an emphasis on persons living in the states prioritized in the US HHS’ “Ending the HIV Epidemic” (EtHE) plan. Following baseline surveys (completed online, by mail, or by phone) and HIV VL testing (via self-collected dried blood spot samples), participants will be randomized to receive or not receive each of the four intervention components in a fractional factorial design. Follow-up surveys will occur at 3, 6, and 12 months, and VL testing at 6 and 12 months. Surveys will assess HRQOL, engagement in care, mental health, covariates, and hypothesized mediators (e.g., social support, HIV stigma, self-efficacy, eHealth literacy). Primary outcomes are VL suppression and HRQOL, and secondary outcomes are engagement in care and depressive symptoms. In line with the MOST framework, each component’s impact on VL and HRQOL will be evaluated, and an optimized intervention identified. We will also assess information related to the acceptability, feasibility, and cost of intervention components. We hypothesize that components will increase (1) the proportion of participants that have VL suppression and (2) HRQOL. Results from this study will provide us with tools to improve health outcomes for rural older PLH and to advance the EtHE plan to eliminate HIV transmission in the US.

在美国，超过55，000名艾滋病毒感染者（PLH）生活在农村地区，2，300多名农村 每年都有居民被诊断出感染艾滋病毒。生活在农村地区的艾滋病毒携带者死亡率高于 在非农村地区，农村的艾滋病毒携带者被诊断出感染艾滋病毒的时间比非农村的人要早 并在以后接受医疗护理，使他们更有可能面临合并症，需要复杂的医疗护理。 在乎农村艾滋病毒携带者也比城市艾滋病毒携带者更不可能继续从事艾滋病毒护理， 病毒被抑制与年轻的PLH相比，老年PLH可能面临更多的挑战，以维持其 健康和福祉，以及也生活在农村地区的老年艾滋病毒携带者面临双重挑战的前景， 在农村环境中生活时坚持艾滋病毒护理和管理医疗条件。几 存在旨在增加VL抑制和改善健康相关生活质量（HRQOL）的干预措施， 农村老年人我们以前对全国农村老年PLH的定性和调查研究（N = 476） 社会支持不足、艾滋病毒相关的耻辱、缺乏技术途径和结构性障碍（如 住房、食品、交通和保险方面的困难）作为参与艾滋病毒护理的关键预测因素， 负荷（VL）抑制和HRQOL。在此基础上，我们建议开发一个 采用多阶段优化策略（MOST）对农村老年PLH进行优化干预。我们将评估 根据循证干预措施改编并远程提供的四个干预措施组成部分： (1)咨询师促进的同伴社会支持，（2）减少艾滋病毒污名，（3）基于实力的病例管理， （4）个性化的技术使用优化。我们将在全国范围内招募400名农村老年艾滋病毒携带者， 与社区机构和在线广告建立伙伴关系， 美国卫生与公众服务部（HHS）的“结束艾滋病流行”（EtHE）计划中的优先事项。基线调查之后 （通过在线、邮件或电话完成）和HIV VL检测（通过自行采集的干血斑样本）， 参与者将被随机分配接受或不接受四种干预成分中的每一种， 部分析因设计将在3、6和12个月时进行随访调查，并在6和12个月时进行VL检测 个月调查将评估HRQOL、参与护理、心理健康、协变量和假设 介体（例如，社会支持、艾滋病毒污名、自我效能、电子卫生知识）。主要结局为VL 抑制和HRQOL，次要结局是参与护理和抑郁症状。一致 在MOST框架下，将评估每个组成部分对VL和HRQOL的影响，并优化 干预措施确定。我们还将评估与可接受性、可行性和成本相关的信息， 干预措施。我们假设组件将增加（1）参与者的比例， （2）HRQOL。这项研究的结果将为我们提供改善健康的工具 为农村老年艾滋病病毒携带者取得成果，并推进EtHE计划，以消除美国的艾滋病毒传播。