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

背景资料。性和性别少数(SGM)青年是感染艾滋病毒人数最多的人 巴西的感染。虽然艾滋病毒可以通过正在进行的抗逆转录病毒治疗(ART)来控制，但异常高 遵守程度是必需的。巴西实施了一项全面的艾滋病毒治疗计划， 获得抗逆转录病毒治疗，但该计划没有具体解决最佳抗逆转录病毒治疗坚持的障碍，特别是 对于SGM青少年，他们经历了许多挑战，按处方服药。概述。这 应用程序寻求开发和试点基于理论的、集成的技术和咨询干预措施 在巴西里约热内卢，改善感染艾滋病毒的SGM青年(15-24岁)对抗逆转录病毒药物的坚持。这个 干预旨在提高社会支持、学习艺术的自我效能感以及教授解决问题的技能 促进更好遵守的障碍。为了告知建议干预的内容、结构和格式， MPI最近与SGM青年(N=18)和主要线人访谈(N=7)进行了焦点小组讨论 与里约热内卢SGM青年密切合作的当地艾滋病毒服务组织的医疗提供者和工作人员 里约热内卢。在焦点小组和关键线人访谈中，普遍同意干预 应利用和加强特别代表青年的社会支持结构，并解决他们的具体问题 关注，特别是与个人(例如，艺术副作用、情绪、物质使用)、社会(例如， 艾滋病毒/SGM污名)，以及他们经常面临的结构性障碍(例如，门诊时间、交通问题)。 理论模型。该干预是以社会认知和社会支持理论为指导的 立足于巴西感染艾滋病毒的SGM青年的社会和背景现实。具体地说，社交 强调支持，并解决信息、解决问题和认知行为的“步骤”。 4组遵守咨询会议，其中包括寻求正常化遵守的短视频插曲 挑战。此外，作为干预的一部分，每天都会发送定制的短信，以方便 社交认知提示按处方服药。研究计划。阶段1：改进和增强 参与者对干预措施的可接受性，并解决与干预措施交付/实施有关的任何问题； 这将通过召集我们的青年社区咨询委员会并从他们那里获得反馈来实现 在整个这一阶段和随后的阶段；并进行一项开放阶段的试点，最多有12个SGM 青年，通过干预后的离职访谈，以及从我们的青年社区咨询中获得反馈 董事会贯穿于这一阶段和随后的阶段。阶段2：在试点随机对照试验中检查 拟议干预措施在72名SGM青年中的可行性、可接受性和潜在影响 同样随机地接受干预或时间和注意力匹配的对照条件，并采用标准护理。 结果是改善了抗逆转录病毒治疗的依从性(Wisepill、药房评估和自我报告)，在 护理和病毒载量抑制。研究评估将在基线、3个月和6个月进行。

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.