Positive Connections: COPA2

抽象的。“治疗”艾滋病毒感染者，即那些没有继续接受治疗的人，是艾滋病毒/艾滋病防治的一个关键重点。 积极预防，因为保持护理也与整体社区水平病毒感染的减少有关。 负担与护理挂钩、及早开始抗逆转录病毒疗法、坚持和保留治疗 使艾滋病毒感染者能够达到并维持病毒抑制到不可检测的水平， 健康和减少艾滋病毒传播。阿根廷是最早保证 艾滋病毒预防、诊断和综合护理服务，包括抗逆转录病毒药物， 消除了费用和获得治疗艾滋病毒感染者的障碍。然而，在美国，辍学发生在 艾滋病的各个阶段据估计，阿根廷有110 000人感染艾滋病毒;其中， 77，000人（70%）已被诊断，60，000人（54%）与护理有关。然而，只有36%的人实现了 病毒抑制和31%的诊断延迟进入护理。我们的试点研究估计， 护理率为65- 90%。由于普遍获得护理，艾滋病毒感染者不受控制， 由于病毒耐药性、治疗失败和艾滋病毒感染的可能性增加， 传输为了在社区一级切实减少艾滋病毒感染， 必须制定战略，使没有继续接受护理的病人重新参与。 动机性访谈（MI）是一种广泛使用的以患者为中心的协作方法， 由治疗师在中美洲和南美洲，以提高动机和承诺，在物质使用和风险 还原我们最近完成的试点可行性研究针对的是没有保留治疗的挑战性患者 在阿根廷布宜诺斯艾利斯的公共和私人诊所。试点研究，利用MI和文化 根据当地环境量身定制，是可行的，并为患者，医生和诊所工作人员所接受。结果 证明了基于医生的MI干预在使患者重新参与护理方面是有效的，即， 增强和维持患者依从性、病毒抑制和医患沟通， 在基线后6个月和9个月，这些患者对治疗的态度。 拟议的临床试验旨在将这些发现扩展到4个城市人口的公共和私人诊所 阿根廷的中心，其中诊所（N = 6家诊所，每个中心6名MD）被随机分配至实验性（医生 MI干预）（n = 3）或对照（医生标准治疗）（n = 3）条件，比例为3：3。使用群集 随机临床试验设计，拟议的研究将测试基于医生的动机的有效性 访谈干预，以改善和维持保留，坚持，持久性和病毒抑制 在“挑战性”患者中（n = 360），24个月内。结果将对公共卫生产生重要影响 实施MI，以重新吸引和留住患者接受艾滋病毒治疗和护理，并改善病毒 通过高水平的药物依从性抑制。

Abstract. “Challenging” HIV-infected patients, those not retained in treatment, represent a critical focus for positive prevention, as retention in care is also associated with reduction in overall community-level viral burden. Linkage to care, early initiation of antiretroviral therapy (ART), adherence and retention in treatment enables HIV-infected individuals to achieve and maintain viral suppression to non-detectable levels, optimizing health and reducing HIV transmission. Argentina was one of the first Latin American countries to guarantee HIV prevention, diagnosis and comprehensive care services, including antiretroviral (ARV) medication, which removed cost and access as barriers to care for HIV-infected patients. Yet, as in the USA, drop out occurs at every stage of the HIV continuum. An estimated 110,000 individuals are HIV-infected in Argentina; of these, 77,000 (70%) have been diagnosed and 60,000 (54%) were linked to care. However, only 36% have achieved viral suppression and 31% of those diagnosed delayed entry to care. Our pilot study estimated retention in care ranged from 65-90%. Given universal access to care, patients with uncontrolled HIV constitute an urgent public health problem due to the increased likelihood of viral resistance, treatment failure and HIV transmission. To achieve meaningful reductions in HIV infection at the community level, new and innovative strategies must be developed to re-engage patients not retained in care. Motivational Interviewing (MI) is a widely used collaborative patient-centered approach and has been used by therapists in Central and South America to enhance motivation and commitment in substance use and risk reduction. Our recently completed pilot feasibility study targeted challenging patients not retained in treatment in public and private clinics in Buenos Aires, Argentina. The pilot study, which utilized MI and was culturally tailored to the local setting, was feasible and acceptable to patients, physicians and clinic staff. Results demonstrated that a physician-based MI intervention was effective in re-engaging patients in care, i.e., enhanced and sustained patient adherence, viral suppression and patient-physician communication and attitudes about treatment among these patients at 6 and 9 months post baseline. The proposed clinical trial seeks to extend these findings in public and private clinics in 4 urban population centers in Argentina, in which clinics (N = 6 clinics, 6 MDs per site) are randomized to experimental (physician MI Intervention) (n = 3) or control (physician Standard of Care) (n = 3) conditions in a 3:3 ratio. Using a cluster randomized clinical trial design, the proposed study will test the effectiveness of a physician-based Motivational Interviewing intervention to improve and sustain retention, adherence, persistence and viral suppression among “challenging” patients (n = 360) over 24 months. Results will have important public health implications for the implementation of MI to re-engage and retain patients in HIV treatment and care and improve viral suppression through high levels of medication adherence.