Exploring Real-time ART Adherence Monitoring In Young African American MSM

摘要 这一探索性/开发性应用建议确定一种有前途的新的 使用实时依从性监测进行干预并确定错过抗逆转录病毒治疗的原因 年轻AAMSM的(ART)剂量。坚持抗逆转录病毒治疗对于预防疾病的发病率、死亡率和出现 抗药性病毒。坚持接触前预防(PrEP)和抗逆转录病毒药物是预防艾滋病毒的关键 变速箱。在美国，按种族划分，非洲裔美国人男性在新的艾滋病毒感染中所占比例最大 并经历不成比例的相关死亡。在接受抗逆转录病毒治疗的艾滋病毒阳性者中，非洲 与白人和西班牙裔相比，美国人受到病毒抑制的可能性要小得多。另外，杨格 男男性行为者对PrEP的依从性低。以信息动机、行为技能模型、实时为导向 对错过的剂量进行分流反应的依从性监测可能会增加患者关于 不坚持的后果，激励服药坚持，并积极影响坚持 行为技能，从而改善导致病毒抑制和/或更持久的行为 保护性的PrEP药物水平。拟议的研究将从艾滋病毒高发人群中招募年轻的AAMSM 提高艺术忠诚度的社区有可能产生高度的个人和公众 健康收益，有可能有助于降低这些社区的艾滋病毒发病率。的目标是 本研究的目的是：1)通过以下方法确定年轻AAMSM患者的实时依从性监测的可接受性 与年轻HIV阳性AAMSM患者的焦点群体进行参与性形成性研究 过去12个月可检测到的病毒载量和正在服用PrEP的年轻AAMSM；2)进行 定性访谈以确定在感染艾滋病毒的年轻患者中实时检测到的错过剂量的原因 在过去12个月内可检测到病毒载量的AAMSM患者。我们将分析采访数据，以 确定导致不遵守的显著行为和/或紧急亚群因素。这些数据 将提供比以前的回顾研究更深入的对ART坚持的理解，并将告知 开发理论驱动的实时艺术坚持干预，包括响应消息的选择， 了解感知到的社会/后勤因素在多大程度上可能对这些事件起作用，并探索 受试者的动机是为了解决错过剂量的原因以防止未来的事件发生。

ABSTRACT This exploratory/developmental application proposes to determine the acceptability of a promising new intervention using real-time adherence monitoring and to determine reasons for missed antiretroviral therapy (ART) doses in young AAMSM. Adherence to ART is critical to prevent morbidity, mortality, and emergence of resistant virus. Adherence to Pre-Exposure Prophylaxis (PrEP) with antiretrovirals is critical to prevent HIV transmission. In the US, African American men account for the largest proportion of new HIV infections by race and disproportionately experience associated mortality. Among HIV-positive persons treated with ART, African Americans are significantly less likely than Whites and Hispanics to be virally suppressed. In addition, young MSM have low adherence to PrEP. Guided by the Information Motivation, Behavioral Skills Model, real-time adherence monitoring with a triaged response to missed doses may increase patient information about the consequences of non adherence, motivate medication adherence, and positively influence adherence behavioral skills, resulting in improved behavior that leads to viral suppression and/or more sustained protective PrEP drug levels. The proposed study will recruit young AAMSM from high HIV incidence neighborhoods where improvement in ART adherence has the potential to produce high personal and public health gain, potentially contributing towards lowering HIV incidence rates in these communities. The aims of this study are to: 1) Determine the acceptability of real-time adherence monitoring in young AAMSM by conducting participative formative research with focus groups of young HIV-positive AAMSM patients with detectable viral load in the past 12 months and young AAMSM who are taking PrEP and; 2) Conduct qualitative interviews to determine reasons for missed doses detected in real-time in young HIV-infected AAMSM patients who had a detectable viral load in the past 12 months. We will analyze interview data to identify salient behavioral and/or emergent subpopulation factors that contribute to non adherence. These data will provide a deeper understanding of ART adherence than previous retrospective studies and will inform development of a theory-driven real-time ART adherence intervention including choice of response messages, understanding to what extent perceived social/logistic factors may contribute to these events, and exploring subject's motivation to address reasons for missed doses to prevent future events.