Adherence Connection for Counseling, Education, and Support (ACCESS) - II

新的人类免疫缺陷病毒(HIV+)感染率最高的是黑人和西班牙裔 青少年和青壮年(Aya)。次优抗逆转录病毒治疗(ART)依从性(90%)是 在39%的这一队列中描述，只有一半是病毒学抑制的(艾滋病毒病毒载量和200拷贝/毫升)， 导致高风险的性传播。 坚持行为是复杂的，由多个层面塑造 社会生态(SE)背景。然而，有一个T的稀缺 基于理论的ART依从性干预 一群人。还需要了解与病毒载量相关的症状群 结果或坚持表型。邓恩·纳瓦拉博士，一位K奖获得者护士科学家，建立了 同行主导、技术支持(WebEx)认知行为艺术遵守干预的概念， 咨询、教育和支持的坚持连接(访问)(K23-NR015970)。训练有素的HIV+ 同伴健康教练提供了为期五个疗程的ART坚持干预，使用视频会议对难以 达到黑人和西班牙裔HIV+Aya与未被抑制的HIV病毒载量。ART剂量增加32% (95可信区间=11.2~53.3)，12个月时HIV病毒载量下降0.28log10(47.5%)。定性研究结果 重点强调了SE对ART遵从性的影响，借出了关于普遍存在的艾滋病毒的改进/新访问内容 耻辱、药物使用/心理困扰，以及与艾滋病毒保健系统接触的重要性。 PI寻求机会扩大这一前景光明的艾滋病毒生物行为研究计划，并加强她的 职业生涯从新的调查员身份过渡到独立调查员身份。在拟议的抗逆转录病毒治疗坚持干预中， ACCESS II，我们的目标是：1)评估ACCESS-II对自我报告抗逆转录病毒治疗的主要结果的影响 依从性与HIV病毒载量和自我效能、HIV知识、HIV污名、 心理困扰、社会支持和物质使用；以及2)确定哪些自尊因素(自我效能、艾滋病毒 知识、艾滋病毒污名、心理困扰、社会支持和物质使用)与抗逆转录病毒治疗有关 依从性和艾滋病毒病毒载量结果。我们的方法包括使用纵向(12周和24周)，两周- 随机对照试验，黑人和西班牙裔HIV+Aya，年龄18-29岁(N=120)。参与者： 干预条件将使用视频会议与训练有素的HIV+同伴健康同步连接 教练将提供每周八次、60分钟的认知行为激励课程，以提高艺术水平 坚持不懈。控制中的参与者将异步连接到基于网络的HIV ART坚持 教育条件。我们将使用线性和广义线性混合模型来检验 关于主要和次要结果的信息获取II。粘附性表型将通过视觉识别 图形分析(VGA)检查和分类3天自我报告的ART依从性的个体轨迹。 总而言之，Access II是一种创新的方法，可以让黑人和西班牙裔艾滋病毒+Aya参与到亟需的 坚持干预，以先前的研究结果(K23)和目前证据基础中的差距来证明是合理的。

The highest rates of new human immunodeficiency virus infection (HIV+) are among Black and Hispanic adolescents and young adults (AYA). Suboptimal antiretroviral treatment (ART) adherence (<90%) is described among 39% of this cohort, and only half are virologically suppressed (HIV viral load <200 copies/ml), leading to high risk for sexual transmission. Adherence behavior is complex, shaped by a multi-level socioecological (SE) context. Yet there is a paucity of t heory based ART adherence interventions for this cohort. There is also a need to gain understanding of the symptom clusters associated with viral load outcomes or adherence phenotypes. Dr. Dunn Navarra, a K awardee nurse scientist, established proof of concept for a peer-led, technology-enabled (WebEx) cognitive behavioral ART adherence intervention, Adherence Connection for Counseling, Education, and Support (ACCESS) (K23-NR015970). Trained HIV+ peer health coaches delivered a five-session, ART adherence intervention, using videoconferences for hard-to- reach Black and Hispanic HIV+AYA with unsuppressed HIV viral load. ART doses taken increased by 32% (95th CI=11.2 to 53.3) with a 0.28 log10 (47.5%) reduction in HIV viral load at 12 months. Qualitative findings highlighted SE influences on ART adherence lending to refined/new ACCESS content on pervasive HIV stigma, substance use/psychological distress, and the importance of engagement with the HIV health system. The PI seeks the opportunity to expand this promising program of HIV biobehavioral research and enhance her career transition from new to independent investigator status. In the proposed ART adherence intervention, ACCESS II, we aim to: 1) evaluate the effect of ACCESS-II on the primary outcomes of self-reported ART adherence and HIV viral load and secondary outcomes of self-efficacy, HIV knowledge, HIV stigma, psychological distress, social support, and substance use; and 2) identify which SE factors (self-efficacy, HIV knowledge, HIV stigma, psychological distress, social support, and substance use) are associated with ART adherence and HIV viral load outcomes. Our methods include using a longitudinal (12 and 24-weeks), two- group, randomized control trial with Black and Hispanic HIV+AYA, ages 18-29 years (N=120). Participants in the intervention condition will use videoconferencing to connect synchronously with trained HIV+ peer health coaches who will deliver eight weekly, 60-minute cognitive behavioral motivational sessions for improved ART adherence. Participants in the control will connect asynchronously to a web-based HIV ART adherence education condition. We will use linear and generalized linear mixed models to examine the efficacy of ACCESS II on primary and secondary outcomes. Adherence phenotypes will be identified using visual graphical analysis (VGA) to examine and classify individual trajectories of 3-day self-reported ART adherence. In summary, ACCESS II is an innovative approach to engage Black and Hispanic HIV+AYA in a much needed adherence intervention, justified with prior research findings (K23) and current gaps in the evidence-base.