ADELANTE: A Randomized Controlled Trial of an Intervention to Improve Engagement in Care for Latinos with HIV

ADELANTE：一项旨在提高拉丁裔艾滋病毒感染者护理参与度的干预措施的随机对照试验

• 批准号: 10757099
• 负责人: Julie Levison
• 金额: $ 82.23万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-25 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10757099
• 关键词: 2 arm randomized control trial; Acute; Address; Adherence; Affect; Anti-Retroviral Agents; Area; Biometry; Caring; Clinic; Clinical; Clinical Trials; Clinical effectiveness; Communication Tools; Community Health Aides; Consolidated Framework for Implementation Research; Cultural Diversity; Data; Development; Discrimination; Disparity; Education; Effectiveness; Emergency department visit; Ensure; Epidemic; Evidence based intervention; Film; Focus Groups; Fright; Funding; Future; Geographic Locations; Geography; HIV; HIV/AIDS; Health; Health Services Accessibility; Health system; Homophobia; Hospitalization; Immigrant; Implementation readiness; Incidence; Individual; Intervention; Intervention Trial; Interview; Language; Latino; Latino Population; Leadership; Link; Massachusetts; Mediating; Mediation; Medicine; Mental Health; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Migrant; Modeling; National Institute of Mental Health; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Poverty; Prevalence; Primary Care; Principal Investigator; Printing; Problem Solving; Provider; Public Health; RNA; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Research Personnel; Research Support; Resources; Self Efficacy; Services; Site; Social Work; Structure; Technology; Telephone; Testing; Time; Training; Transportation; Treatment outcome; Underserved Population; United States National Institutes of Health; Viral; Viral Load result; Well in self; Work; acceptability and feasibility; community engagement; community partnership; empowerment; enhanced care; epidemic preparedness; future implementation; health care service utilization; health communication; health disparity; implementation facilitators; improved; improved outcome; intersectionality; multidisciplinary; patient retention; programs; social stigma; substance use; theories; therapy design; tool; transportation access; uptake

Latinos with HIV are persistently underserved in the U.S., contributing to poor clinical outcomes and public health burden. While effective antiretroviral medications are widely available, only half of Latino patients with HIV are retained in care and have regular access to treatment. Barriers to HIV care for Latinos are numerous, multi-factorial, and dynamic, such as fear of deportation, stigma, homophobia, emotional well-being and mental health, inadequate access to transportation to attend clinics, lack of access to primary care, and shortage of trained providers who can provide culturally attuned care in Spanish. Using culturally acceptable tools can help these patients overcome existing impediments and develop greater patient activation, self-efficacy, and emotional well-being and access to the needed core social services on the pathway to viral suppression. The PI’s recent NIMH-funded K23 award developed and evaluated a Spanish language telenovela-(film) based, community health worker (CHW)-delivered 5-session intervention, called ADELANTE, which is a theory-based problem-solving intervention designed to empower Latinos with HIV and link them to existing resources, such as transportation, to address unmet basic needs. The proposed R01, led by an Early Stage Investigator, will test ADELANTE in two Ryan White-funded clinics within US Ending the HIV Epidemic (EHE) Plan-identified geographic areas that have high HIV incidence in Latinos. Building on our prior research and grounded in local EHE priorities, we will leverage well-established community partnerships and multidisciplinary expertise in clinical trials, health disparities, mental health and substance use, community engagement, and biostatistics to accomplish the following aims. In Aim 1, we will randomize 250 Latinos with HIV in a controlled trial to contrast clinical effectiveness of ADELANTE (5-session, CHW-delivered telenovela-based intervention) versus enhanced care condition (ECC, 5 reminder phone calls). We hypothesize that ADELANTE participants will demonstrate higher rates of viral suppression (HIV RNA <200 copies/ml) at month-12 and will have fewer ED visits and hospitalizations compared with ECC. In Aim 2, we will examine potential mechanisms by which ADELANTE impacts viral suppression. We hypothesize that participants in ADELANTE will have increased rates of patient activation, self-efficacy for retention in care, emotional well-being, and referrals for non- clinical services and these variables will mediate the relationship of ADELANTE with viral suppression. In Aim 3, we will identify barriers and facilitators to implementation readiness of ADELANTE through in-depth semi-structured interviews with 40 RCT participants and focus groups with local stakeholders involved with implementation. This qualitative data will add value in explaining findings, ensuring relevance, and facilitating future uptake and reach. This approach addresses high priority areas for NIH HIV/AIDS research by advancing research to reduce health disparities. We anticipate that the merger of technology and CHWs with culturally relevant content will improve outcomes for Latinos with HIV towards ending the HIV epidemic.

在美国，感染艾滋病毒的拉美裔人一直得不到充分的服务，这导致了临床结果不佳和公众不满