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

在美国，超过55,000名艾滋病毒(PLH)携带者生活在农村地区，超过2,300名农村患者 居民每年都被诊断出感染了艾滋病毒。与居住在农村的PLH相比，PLH的死亡率更高 与非农村的公共卫生部门合作。与非农村人相比，农村公共卫生机构被诊断出感染艾滋病毒的阶段更晚 和以后的医疗护理，使他们更有可能面临合并症和需要复杂的医疗 关心。农村公共卫生机构也比城市人员更不可能继续从事艾滋病毒护理工作，也不太可能 病毒被抑制了。与较年轻的公屋相比，较年长的公屋可能会面对额外的挑战，以维持其 健康和福祉，以及同样生活在农村地区的老年人面临着双重挑战的前景 在生活在农村环境的同时，坚持艾滋病毒护理和管理医疗条件。一些 旨在加强病毒抑制和改善健康相关生活质量(HRQOL)的干预措施已经存在 为农村较老的PLH提供服务。我们之前对全国农村老年PLH(N=476)的定性和调查研究 发现社会支持低、艾滋病毒相关的耻辱、自我效能和结构性障碍(例如 住房、食品获取、交通和保险)是参与艾滋病毒护理的关键预测因素 压抑，以及这一人群的HRQOL。在此基础上，我们之前试行了两个远程交付的 对农村老年PLH的干预：支持性-表现型同伴社会支持团体和基于优势的病例 管理层。美国南部农村较老的PLH试点发现干预措施是可行的， 可接受的，并显示初步影响的证据。基于这项工作，我们建议进行一项全面的试验 评估这两种干预措施的效果。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“结束艾滋病毒流行”(Ethe)计划中优先考虑的州--通过伙伴关系 与社区机构和在线广告合作。遵循基线调查(在线、邮寄或 通过电话)和艾滋病毒病毒载量测试(通过自我收集的干血点样本)，参与者将 随机接受或不接受2x2析因设计中的每个干预。后续调查将在以下时间进行 4个月、8个月和12个月，以及4个月和12个月的病毒负载测试。调查将评估服药依从性， 抑郁症状、HRQOL、协变量和潜在的中介因素(例如，社会支持、艾滋病毒污名、自我 效率、结构性障碍)。主要结果是病毒抑制，抗逆转录病毒治疗坚持， 抑郁症状和HRQOL以及次要结果是潜在的中介机制。我们 假设两种干预措施都会增加接受病毒抑制的参与者的比例， 水平的抗逆转录病毒治疗依从性，以及HRQOL和减少抑郁症状。探索性的 分析将评估干预效果的调解人和调解人。我们还将评估可接受性， 可行性，以及实施干预的成本。这项研究的结果将为我们提供改善健康的工具 改善农村老年PLH的效果，并推进在美国消除艾滋病毒传播的计划。

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.