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

新的人类免疫缺陷病毒感染（艾滋病毒+）的最高比率是黑人和西班牙裔 青少年和年轻人（AYA）。不理想的抗逆转录病毒治疗（ART）依从性（<90%）是 在该队列的39%中描述，并且只有一半被病毒学抑制（HIV病毒载量<200拷贝/ml）， 导致性传播的高风险。 依附行为是复杂的，由多层次的 社会生态学（SE）。然而，T 基于理论的ART依从性干预 队列。还需要了解与病毒载量相关的症状群 结果或依从性表型。邓恩纳瓦拉博士，一个K奖护士科学家，建立了证据， 同伴主导的、技术支持的（WebEx）认知行为ART依从性干预的概念， 咨询、教育和支持的依从性连接（ACCESS）（K23-NR 015970）。艾滋病毒+培训 同伴健康教练提供了一个五个会议，ART依从性干预，使用视频会议， 达到黑人和西班牙裔艾滋病毒+AYA与未抑制的艾滋病毒载量。抗逆转录病毒治疗剂量增加32% (95th CI=11.2 - 53.3），12个月时HIV病毒载量降低0.28 log 10（47.5%）。定性结果 强调了SE对ART依从性的影响，以及对关于普遍存在的艾滋病毒的改进/新的ACCESS内容的借贷 耻辱、药物使用/心理困扰以及参与艾滋病毒卫生系统的重要性。 PI寻求机会扩大这一有前途的艾滋病毒生物行为研究计划，并提高她的能力。 从新人到独立调查员的职业过渡。在拟议的抗逆转录病毒疗法依从性干预中， ACCESS-II，我们的目标是：1）评估ACCESS-II对自我报告的ART主要结局的影响 依从性和HIV病毒载量以及自我效能、HIV知识、HIV污名、 心理困扰、社会支持和物质使用; 2）确定哪些SE因素（自我效能、艾滋病毒 知识、艾滋病污名、心理困扰、社会支持和药物使用）与抗逆转录病毒疗法有关 依从性和HIV病毒载量结果。我们的方法包括使用纵向（12周和24周），两个- 组，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受过培训的艾滋病毒+同伴健康同步连接 教练将提供每周8次，60分钟的认知行为激励课程，以改善ART 坚持。对照组的参与者将异步连接到基于网络的HIV ART依从性 教育条件。我们将使用线性和广义线性混合模型来检验 关于主要和次要结局的ACCESS II。将使用目视检查确定依从性表型 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。 总之，ACCESS II是一种创新方法，可以让黑人和西班牙裔艾滋病毒+AYA参与急需的 依从性干预，根据先前的研究结果（K23）和现有证据基础的差距进行论证。

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.