Making universal, free-of-charge antiretroviral therapy work for sexual and gender minority youth in Brazil

为巴西的性少数群体和性别少数青年提供普遍、免费的抗逆转录病毒治疗

• 批准号: 10274560
• 负责人: Katie Brooks Biello
• 金额: $ 22.78万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10274560
• 关键词: 19 year old; Address; Adherence; Age; Agreement; Anti-Retroviral Agents; Appointment; Attention; Behavioral; Behavioral Model; Bisexual; Brazil; Caring; Charge; Clinic; Cognitive; Communities; Counseling; Cues; Data; Development; Dose; Ensure; Face; Feedback; Focus Groups; Fostering; Funding; Future; Gays; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Healthy Eating; Hour; Incidence; Individual; Institutes; Intervention; Interview; Measures; Mediator of activation protein; Medical; Medical Records; Methods; Moods; Morbidity - disease rate; Motivation; National Institute of Mental Health; Outcome; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacy facility; Phase; Plasma; Population; Population Intervention; Prevalence; Prevention; Problem Solving; Procedures; Process; Provider; Qualitative Research; Randomized; Randomized Controlled Trials; Records; Reporting; Research; Risk; Self Efficacy; Services; Sexual Transmission; Sexual and Gender Minorities; Sexual and Gender Minority Youth; Social support; Standardization; Structure; Technology; Testing; Text Messaging; Theoretical model; Time; Transportation; Travel; Viral; Viral Load result; Work; Youth; aged; antiretroviral therapy; arm; base; efficacy trial; experience; group counseling; group intervention; improved; improved outcome; informant; men; mortality; pilot trial; post intervention; pre-exposure prophylaxis; primary outcome; programs; recruit; service organization; side effect; skills; social; social stigma; standard of care; substance use; theories; therapy adherence; therapy development; transgender women; transmission process; treatment adherence; treatment program

Background. Sexual and gender minority (SGM) youth account for the largest number of incident HIV infections in Brazil. Although HIV can be managed with ongoing antiretroviral therapy (ART), exceptionally high levels of adherence are required. Brazil has implemented a comprehensive HIV treatment program with broad access to ART, but this program does not specifically address barriers to optimal ART adherence, particularly for SGM youth who experience many challenges taking their medication as prescribed. Overview. This application seeks to develop and pilot test a theory-based, integrated technology and counseling intervention to improve ART adherence among HIV infected SGM youth (ages 15-24) in Rio de Janeiro, Brazil. The intervention aims to improve social support, self-efficacy for taking ART, and teach skills for problem-solving barriers to promote better adherence. To inform the content, structure, and format of the proposed intervention, the MPIs recently conducted focus groups with SGM youth (N = 18) and key informant interviews (N = 7) with medical providers and staff at local HIV service organizations working closely with SGM youth in Rio de Janeiro. Across focus groups and key informant interviews there was universal agreement that an intervention should capitalize on and enhance social support structures among SGM youth, and address their specific concerns, especially as related to the individual (e.g., ART side effects, mood, substance use), social (e.g., HIV/SGM stigma), and structural (e.g., clinic hours, transportation challenges) barriers that they regularly face. Theoretical Model. The intervention is guided by Social Cognitive and Social Support Theories and is grounded in the social and contextual realities of SGM youth living with HIV in Brazil. Specifically, social support is emphasized and informational, problem-solving and cognitive-behavioral “steps” are addressed over 4-group adherence counseling sessions, which include short video vignettes that seek to normalize adherence challenges. In addition, daily tailored SMS text messages are delivered as part of the intervention to facilitate social-cognitive cues to take medications as prescribed. Research Plan. Phase 1: Refine and enhance participant acceptability of the intervention and resolve any issues with intervention delivery/implementation; this will be achieved by convening and obtaining feedback from our youth community advisory board throughout this phase and subsequent phases; and by conducting an open-phase pilot with up to 12 SGM youth, with post-intervention exit interviews, as well as obtaining feedback from our youth community advisory board throughout this and subsequent phases. Phase 2: Examine, in a pilot randomized controlled trial, the feasibility, acceptability and potential impact of the proposed intervention among 72 SGM youth who will be equally randomized to the intervention or a time- and attention-matched control condition with standard of care. The outcomes are improved ART adherence (Wisepill, pharmacy assessment and self-report), retention in care and viral load suppression. Study assessments will be conducted at baseline, 3- and 6-months.

背景。性和性别少数群体（SGM）青年是感染艾滋病毒人数最多的群体