Testing the Efficacy of Two Interventions to Improve Health Outcomes and Quality of Life among Rural Older Adults Living with HIV

测试两种干预措施对改善农村艾滋病毒感染者健康状况和生活质量的效果

• 批准号: 10619130
• 负责人: ANDREW E PETROLL
• 金额: $ 64.81万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-28 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619130
• 关键词: Acceleration; Adherence; Advertisements; Age; Aging; Baseline Surveys; Blood; Caring; Case Management; Collection; Communities; Complex; Dependence; Diagnosis; Discrimination; Dryness; Elderly; Enrollment; Epidemic; Evidence based intervention; Face; Food Access; Gender; Goals; HIV; HIV diagnosis; Health; Healthcare Systems; Housing; Individual; Insurance; Intervention; Manuals; Mediating; Mediator; Medical; Morbidity - disease rate; Motivation; Newly Diagnosed; Outcome; Participant; Personal Satisfaction; Persons; Pharmaceutical Preparations; Population; Provider; Quality of life; Race; Randomized; Reporting; Research; Resources; Rural; Rural Population; Sampling; Self Efficacy; Services; Social isolation; Social support; Spottings; Support Groups; Surveys; Technology; Telephone; Testing; Transportation; Viral; Viral Load result; Work; acceptability and feasibility; antiretroviral therapy; barrier to care; cognitive ability; comorbidity; depressive symptoms; design; eHealth; efficacy evaluation; efficacy testing; efficacy trial; epidemic preparedness; follow-up; health disparity; health equity; health related quality of life; improved; informal caregiver; intervention cost; intervention delivery; intervention effect; medication compliance; mortality; peer; primary outcome; recruit; remote assessment; remote delivery; remote intervention; rural area; rural counties; rural dwellers; rural environment; rural residence; rural setting; scale up; secondary outcome; service utilization; social; social interventions; social stigma; success; therapy adherence; tool; transmission process

More than 55,000 people living with HIV (PLH) in the US live in rural areas, and more than 2,300 rural residents are diagnosed with HIV each year. PLH who live in rural areas have higher mortality rates compared with non-rural PLH. Rural PLH are diagnosed with HIV at a more advanced stage than non-rural individuals and present for medical care later, making them more likely to face comorbidities and need complex medical care. Rural PLH are also less likely than their urban counterparts to remain engaged in HIV care and to be virally suppressed. Compared with younger PLH, older PLH may face additional challenges to maintaining their health and wellbeing, and older PLH who also live in rural areas face the doubly challenging prospect of maintaining adherence to HIV care and managing medical conditions while living in a rural environment. Few interventions aimed at increasing viral suppression and improving health-related quality of life (HRQOL) exist for rural older PLH. Our previous qualitative and survey research with rural older PLH nationwide (N = 476) identified low social support, HIV-related stigma, self-efficacy, and structural barriers (such as difficulties with housing, food access, transportation, and insurance) as key predictors of engagement in HIV care, viral suppression, and HRQOL for this population. Based on this, we previously piloted two remotely-delivered interventions for rural older PLH: supportive-expressive peer social support groups and strengths-based case management. The pilot with older PLH in the rural Southern U.S. found the interventions to be feasible, acceptable, and to show evidence of preliminary impact. Based on this work, we propose a full-scale trial to evaluate the efficacy of these two interventions. We will recruit 352 rural older PLH in the Southern U.S.— including in the states prioritized in the US HHS’ “Ending the HIV Epidemic” (EtHE) plan—through partnerships with community agencies and online advertisements. Following baseline surveys (completed online, by mail, or by phone) and HIV viral load testing (via self-collected dried blood spot samples), participants will be randomized to receive or not receive each intervention in a 2x2 factorial design. Follow-up surveys will occur at 4, 8, and 12 months, and viral load testing at 4 and 12 months. Surveys will assess medication adherence, depressive symptoms, HRQOL, covariates, and potential mediators (e.g., social support, HIV stigma, self- efficacy, structural barriers). Primary outcomes are viral suppression, antiretroviral therapy adherence, depressive symptoms and HRQOL, and secondary outcomes are potential mediating mechanisms. We hypothesize that both interventions will increase the proportion of participants that have viral suppression, levels of antiretroviral therapy adherence, and HRQOL and decrease depressive symptoms. Exploratory analyses will evaluate mediators and moderators of intervention effects. We will also assess the acceptability, feasibility, and costs of intervention delivery. Results from this study will provide us with tools to improve health outcomes for rural older PLH and to advance the EtHE plan to eliminate HIV transmission in the U.S.

在美国，超过55，000名艾滋病毒感染者（PLH）生活在农村地区，2，300多名农村 每年都有居民被诊断出感染艾滋病毒。生活在农村地区的艾滋病毒携带者死亡率高于 在非农村地区，农村的艾滋病毒携带者被诊断出感染艾滋病毒的时间比非农村的人要早 并在以后接受医疗护理，使他们更有可能面临合并症，需要复杂的医疗护理。 在乎农村艾滋病毒携带者也比城市艾滋病毒携带者更不可能继续从事艾滋病毒护理， 病毒被抑制与年轻的PLH相比，老年PLH可能面临更多的挑战，以维持其 健康和福祉，以及也生活在农村地区的老年艾滋病毒携带者面临双重挑战的前景， 在农村环境中生活时坚持艾滋病毒护理和管理医疗条件。几 存在旨在增加病毒抑制和改善健康相关生活质量（HRQOL）的干预措施 农村老年人我们以前对全国农村老年PLH的定性和调查研究（N = 476） 确定了低社会支持，艾滋病毒相关的耻辱感，自我效能感和结构性障碍（如困难， 住房、食物获取、交通和保险）作为参与艾滋病毒护理的关键预测因素， 抑制和HRQOL。在此基础上，我们之前曾驾驶过两辆远程交付的 农村老年人艾滋病干预：同伴社会支持团体和基于优势案例 管理在美国南部农村的老年PLH试点发现干预措施是可行的， 可以接受，并显示初步影响的证据。基于这项工作，我们提出了一个全面的试验， 评估这两种干预措施的有效性。我们将在美国南部招募352名农村老年PLH- 包括在美国卫生与公众服务部的“结束艾滋病毒流行”（EtHE）计划中优先考虑的州， 社区机构和在线广告。在基线调查（在线、邮寄或 通过电话）和HIV病毒载量检测（通过自我收集的干血斑样本），参与者将 在2x2析因设计中随机接受或不接受每种干预。后续调查将于 4个月、8个月和12个月时进行病毒载量检测。调查将评估药物依从性， 抑郁症状、HRQOL、协变量和潜在介质（例如，社会支持，艾滋病污名，自我- 结构性障碍）。主要结果是病毒抑制，抗逆转录病毒治疗依从性， 抑郁症状和HRQOL以及次要结局是潜在的中介机制。我们 假设这两种干预措施都会增加病毒抑制的参与者比例， 抗逆转录病毒治疗依从性水平和HRQOL并减少抑郁症状。探索性 分析将评估干预效果的中介者和调节者。我们还将评估可接受性， 可行性和干预措施的成本。这项研究的结果将为我们提供改善健康的工具 为农村老年艾滋病病毒携带者取得的成果，并推进EtHE计划，以消除美国的艾滋病病毒传播。