A Multimedia Social Support Intervention: Adherence to HIV Care in South Africa

描述（由申请人提供）：艾滋病毒是对感染者健康和心理社会福祉的主要威胁，特别是在获得抗逆转录病毒治疗机会有限的资源匮乏国家。南非是世界上艾滋病流行率最高的国家之一。最近，南非启动了一项国家计划，在南南非广泛提供抗逆转录病毒治疗，这将导致越来越多的艾滋病毒感染者存活下来，并且必须将艾滋病毒作为一种慢性、耻辱性和传染性疾病生活，并可能造成严重的公共卫生后果。本应用程序的目标是适应和试点测试辅导员和多媒体驱动的社会支持干预，以促进在南非社区诊所获得抗逆转录病毒治疗的成年患者的最佳医疗依从性。最初的干预措施（SMART Couples）是在美国开发和测试的，对象是艾滋病毒阳性的成年人及其血清不一致的伴侣。该课程将在两个主要方面进行修改：(1)我们将修改方法，使其可以用于所有接受抗逆转录病毒治疗的成年患者，允许他们包括其社会网络中的任何成员（而不仅仅是血清不一致的伴侣）；(2)我们将把干预转换成多媒体计算机形式，这样非专业咨询师就可以有效地使用它，只需最少的培训、监督和成本。在第一阶段，我们将使用行为健康的社会行动理论（SAT）模型，为SA成年男性和女性调整SMART课程。我们将使用基于社区的参与式研究方法（CBPR）来修改现有课程，并指定干预和评估交付的程序。与保健工作人员（如护士、医生、心理学家和艾滋病毒咨询师）和获得艾滋病毒服务的患者举行的一系列消费者咨询会议将侧重于使干预措施适应当地环境。现有SMART手册中的内容和新开发的媒体将由这些关键利益相关者和研究团队进行审查。我们将研究干预措施的实施问题，不仅关注后勤，还关注对心理社会干预、艾滋病毒污名和提供者角色的态度，特别是护士和依从性咨询师的角色。通过使用CBPR，我们将就现有SMART干预的哪些组成部分与情景认知相关达成共识，并添加被认为更相关的局部技术，但这也使我们能够保持对核心干预组成部分和我们的理论框架的忠诚。在第二阶段，西开普省南半岛区的三个诊所（福斯湾、维多利亚医院和撤退诊所）的66名艾滋病毒阳性成年患者将参加干预措施的随机对照试验。他们将被随机分为积极干预组和“标准治疗组”。在SAT模型的指导下，参与者将在三个时间点（测试前和测试后干预以及3个月的随访）对依从性和其他行为健康结果、社会支持过程以及其他自我调节和环境变量进行评估。过程变量，包括可行性和可接受性的障碍和促进因素，将从患者和临床工作人员处收集。研究结果可用于在类似环境下进行更大规模的有效性研究。

DESCRIPTION (provided by applicant): HIV is a major threat to the health and psychosocial well-being of infected people, particularly in low-resource countries that have had limited access to antiretroviral treatment (ART). South Africa (SA) has one of the highest HIV prevalence rates in the world. Recently, a national plan was initiated to make ART widely available in SA which will result in a growing population of people living with HIV who survive and must live with HIV disease as a chronic, stigmatizing, and transmittable illness, with the potential for significant public health consequences. The goal of this application is to adapt and pilot test a counselor- and multimedia-driven social support intervention to promote optimal medical care adherence for adult patients accessing ART in SA community based clinics. The original intervention (SMART Couples) was developed and tested in the US with HIV+ adults and their serodiscordant partners. This curriculum will be modified in two primary ways: (1) we will modify the approach so that it can be used with all adult patients on ART, allowing them to include any member of their social network (not just a serodiscordant partner); and (2) we will translate the intervention into a multimedia computer-based format so that it can be used effectively by lay counselors, with minimal training, supervision, and cost. In Phase 1, we will adapt the SMART curriculum for SA adult men and women using a Social Action Theory (SAT) model of behavioral health. We will use community-based participatory research methods (CBPR) to modify the existing curriculum and to specify procedures for intervention and assessment delivery. A series of consumer consultant meetings with health care staff (e.g., nurses, physicians, psychologists, and HIV counselors) and patients accessing HIV services will focus on adapting the intervention for the local setting. Content from the existing SMART manual and newly developed media will be reviewed by theses key stakeholders and the research team. We will examine intervention implementation issues, with attention not only to logistics, but also to attitudes about psychosocial interventions, HIV stigma, and provider roles, particularly those of nurses and adherence counselors. Through the use of CBPR, we will build consensus about which components of the existing SMART intervention are relevant to the SA context and add local techniques that are deemed more relevant, but that also allow us to retain fidelity to core intervention components and our theoretical framework. In Phase 2, 66 HIV+ adult patients at three clinics in the South Peninsula District of the Western Cape (False Bay, Victoria Hospital, and Retreat Clinic) will participate in a pilot randomized controlled trial of the intervention. They will be randomized either to the active intervention or to "standard of care." Participants will be assessed at three time-points (pre- and post-test intervention and 3-month follow-up) on adherence and other behavioral health outcomes, social support processes, and other self-regulation and contextual variables - guided by the SAT model. Process variables, including barriers and facilitators of feasibility and acceptability will be collected from patients and clinic staff. The findings can be used to inform larger-scale effectiveness studies in similar settings.