Masivukeni: A Multimedia ART Adherence Intervention for Resource-Limited Settings

Masivukeni：针对资源有限环境的多媒体 ART 依从干预

• 批准号: 8208860
• 负责人: ROBERT H REMIEN
• 金额: $ 66.08万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-04 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8208860
• 关键词: Address; Adherence; Affect; Africa South of the Sahara; African; Alcohol or Other Drugs use; Behavioral; Biological; CD4 Lymphocyte Count; Caring; Cities; Clinic; Clinical; Collaborations; Communities; Complex; Computers; Counseling; Country; Couples; Data; Disadvantaged; Disease; Drug resistance; Educational process of instructing; Electronics; Goals; Grant; Guideline Adherence; HIV; HIV Infections; Health; Health Policy; Health Services Accessibility; Healthcare; Human Resources; Imagery; Individual; Informal Social Control; Institutes; Intervention; Life; Maintenance; Mediating; Medical; Mental Health; Mental disorders; Modality; Modeling; Monitor; Multimedia; National Institute of Mental Health; Nurses; Outcome; Outpatients; Participant; Patient Care; Patients; Physicians; Pilot Projects; Policy Maker; Poverty; Prevalence; Problem Solving; Professional counselor; Provider; Public Health; Randomized; Randomized Controlled Trials; Regulation; Reporting; Research; Research Infrastructure; Research Methodology; Resistance; Resources; Risk; Science; Screening procedure; Services; Social support; South Africa; Standardization; Supervision; Technology; Testing; Time; Training; Treatment Efficacy; Treatment Failure; Universities; Viral; Viral Load result; Work; antiretroviral therapy; arm; base; clinical care; community based participatory research; contextual factors; coping; efficacy testing; improved; innovation; literacy; medication compliance; meetings; prevent; primary outcome; resistance factors; secondary outcome; skills; social; standard care; success; theories; therapy adherence; transmission process

DESCRIPTION (provided by applicant): South Africa (SA) has the largest number of HIV infections in the world. Although initial reports suggested that rates of ART adherence in sub-Saharan Africa were high, recent data indicate that adherence may be a major obstacle to actualizing the full benefits of ART. Inadequate adherence and associated drug resistance are factors contributing to high rates of treatment failure often observed within the first 12 months of ART initiation. Patient understanding of HIV disease and the necessity for high ART adherence, as well as the social support for maintenance of adherence are key to the long-term success of ART. Given the ratio of physicians/nurses to patients, ART adherence counseling in SA is conducted mostly by lay counselors with varied expertise and skills, and minimal supervision. Lack of standardization and variability in quality of counseling has prompted urgent calls for an effective adherence intervention that can be delivered by trained lay staff (with fidelity) to establish optimal adherence among patients initiating ART. With the support of an NIMH R34 grant, we developed Masivukeni, an innovative, multi-media computer-based intervention developed by our US-SA research team with SA patients and care providers using community based participatory research methods. Based on Social Action Theory, Masivukeni addresses contextual factors that may promote or impede adherence, and self-regulation and social support factors that can improve behavioral and biological outcomes. The utilization of computer-based technology by counselors working with patients and their treatment support partners enables lay counselors with minimal training and supervision to teach complex medical information and problem-solving skills, with culturally relevant, interactive imagery. The intervention also enhances counselor capacity for screening and making referrals for mental health and substance use problems among patients initiating ART. Our pilot study demonstrated high acceptability and feasibility, as well as promising effects on key primary and secondary outcomes. Through a collaboration among City and Provincial DOHs in Cape Town, research and clinical partners in SA (University of Cape Town) and the US (HIV Center for Clinical and Behavioral Studies at NYS Psychiatric Institute/RFMH and CCNMTL at Columbia University), we propose to compare Masivukeni to "standard care" by randomly assigning 360 patients initiating ART to one of the two study conditions in two publicly financed medical clinics serving predominantly poor communities with high HIV prevalence. Patients will be followed over the course of one year. Assessments will be administered to patients at baseline, 6 months and 12 months post baseline. Through partnership with clinicians and DOH policy-makers, the intervention will be quickly available for wide-scale dissemination if shown to be efficacious. Further, an efficacious intervention of this modality could readily be culturally tailored and implemented in other regions of the world, including the US where long-term adherence remains a challenge, particularly for patients with low literacy and mental health and substance use problems. PUBLIC HEALTH RELEVANCE: It is well established that adherence to HIV treatment and care at the time or ART initiation is one of the most significant predictors of long-term clinical success and outcomes for HIV-patients. Further, with optimal medication adherence, patients can achieve undetectable viral loads, significantly reducing the risk of HIV transmission to others. Thus, strategies for enhancing adherence among patients initiating ART are in great demand, particularly in regions of the world with staggering numbers of people living with and still becoming infected with HIV. In the context of (1) "Test, Treat, and Linkage to Care" approaches to improve the public health, and (2) "task-shifting" to lay personnel for adherence counseling, improving the delivery of adherence counseling holds promise for improving both individual and public health.

描述（由申请人提供）：南非（SA）拥有世界上最多的艾滋病毒感染。尽管最初的报道表明，撒哈拉以南非洲的艺术依从性率很高，但最近的数据表明，依从性可能是实现艺术的全部益处的主要障碍。依从性不足和相关的耐药性是导致高治疗失败率的因素，通常在艺术启动的前12个月内观察到。对艾滋病毒疾病的耐心理解以及高度依从性的必要性以及维持遵守的社会支持是艺术长期成功的关键。鉴于医师/护士与患者的比率，SA中的艺术依从性咨询主要由具有多种专业知识和技能的外行辅导员进行，并且监督最少。缺乏标准化和咨询质量的可变性促使紧急呼吁进行有效的依从性干预措施，该干预措施可以由训练有素的外行员工（有足够的忠诚度）提供，以在发起艺术的患者中建立最佳依从性。在NIMH R34赠款的支持下，我们开发了Masivukeni，这是由我们的US-SA研究团队与SA患者和护理提供者开发的创新，基于计算机的干预措施，使用基于社区的参与性研究方法。基于社会行动理论，Masivukeni解决了可能促进或阻碍依从性的上下文因素，以及可以改善行为和生物学结果的自我调节和社会支持因素。与患者及其治疗支持伙伴一起工作的辅导员对基于计算机的技术的利用，使外行辅导员可以通过最少的培训和监督来教授复杂的医疗信息和解决问题的技能，并具有与文化相关的互动图像。干预措施还提高了辅导员的能力，以筛查和推荐针对精神健康和启动艺术的药物使用问题。我们的试点研究表明，可接受性和可行性高，并且对关键主要和次要结果的有希望的影响。通过在开普敦的城市和省级DOH之间的合作，SA（开普敦大学）的研究和临床伙伴和美国（HIV HIV临床和行为研究中心的临床和行为研究中心，哥伦比亚大学的哥伦比亚大学的CCNMTL和CCNMTL），我们建议通过将Masivukeni进行两次供应的属于“标准护理”，以进行两次供应，以进行两次研究，以进行两次供应，以进行两次分配的患者。诊所为艾滋病毒率高的较贫穷社区提供服务。在一年的时间里，将遵循患者。基线后6个月零12个月，将对患者进行评估。通过与临床医生和DOH政策制定者的合作关系，如果证明是有效的，该干预措施将很快进行大规模传播。此外，在世界其他地区，包括长期依从性仍然是一个挑战，尤其是对于低识字率，精神健康和药物使用问题的患者，在包括美国其他地区，可以轻易地对这种方式进行有效的干预措施。 公共卫生相关性：众所周知，当时或艺术启动时遵守HIV治疗和护理是长期临床成功和HIV患者成果的最重要预测指标之一。此外，凭借最佳的药物依从性，患者可以达到无法检测到的病毒载量，从而大大降低了向他人传播HIV的风险。因此，提高启动艺术的患者依从性的策略非常有需求，尤其是在世界各地，与艾滋病毒相处并仍然感染了惊人的人。在（1）“测试，治疗和与Care的联系”的方法，以改善公共卫生，以及（2）“任务移动”以进行依从性咨询的外行人员，改善了依从性咨询的交付持希望，以改善个人和公共卫生。