Social Network Intervention to Engage Out-of-Care PLH Into Treatment

描述(申请人提供)：抗逆转录病毒治疗抑制病毒载量，降低艾滋病毒携带者(PLH)将其感染传染给性伴侣的可能性。 启动HAART既是治疗，也是减少未来艾滋病毒发病率的战略。只有当社区中有高比例的公共卫生机构进入、维持和坚持护理时，治疗即预防才能在公共卫生规模上取得成功。一个几乎没有受到科学关注的问题是，如何让社区中的大量人知道他们的艾滋病毒+状态，但没有接受治疗。解决这一问题的一个潜在的变革性的新战略是通过针对社区中PLH的社会网络--特别是那些目前不在护理中的社区网络--进行干预，以加强和加强网络层面的规范、准备、技能和治疗进入、维护和坚持的计划。这种方法是新颖的，因为它在PLH社区内部创建了规范，以激励治疗参与。这项研究将在俄罗斯圣彼得堡进行，在那里，当代的HAART方案最近才推出，但很大比例的PLH没有得到护理，拒绝接受处方的HAART疗法，或中断治疗。联合国艾滋病规划署的数据显示，东欧除医疗保健外的公共卫生保健比例高于撒哈拉以南非洲，接受HAART治疗的公共卫生保健中有三分之二没有达到最佳水平。我们的初步研究已经证实，PLH在他们的社交网络中还有许多其他PLH，这些网络可以被识别并进行行为干预。将进行为期6个月的形成性研究，以量身定制招募和干预方法。这项研究的主要试验将招募32个三环社会中心社交网络的PLH(n=448)。将对每个参与者的CD4+和HIV病毒载量、护理参与度、HAART依从性和心理社会特征进行基线评估。网络将在两个研究条件下随机进行。比较情况网络成员将在基线时接受关怀动机访谈，然后接受常规服务。被分配到干预条件下的16个社交网络中的每个成员都将接受相同的激励性访谈，以“最大”地关注护理。然后，根据社会地位和在网络结构中的中心地位确定的社会影响力网络领导人将接受培训，在两个月的时间里向其他PLH网络成员提供持续的基于理论的、个人量身定制的建议和咨询。领导人将强调进入、保留和坚持治疗的好处。网络干预的目的是提高网络成员从事医疗保健的比例，增加护理出勤率，减少病毒载量，并在6个月和12个月的随访中提高治疗依从性。我们将研究网络结构特征如何调节干预效果，并将为减少后续发病率而模拟干预影响。这项研究的影响取决于网络干预的潜力，以使社区中的公共卫生机构进入并坚持护理。该模式将适用于国际环境和美国。

DESCRIPTION (provided by applicant): Antiretroviral therapy suppresses viral load, reducing the likelihood that persons living with HIV (PLH) will transmit their infection to sexual partners. Initiation of HAART is both treatment and also a strategy to reduce future HIV incidence. Treatment-as-prevention can only be successful on a public health scale when a high proportion of PLH in the community enter, maintain, and adhere to care. A question that has received almost no scientific attention is how to reach the large number of persons in the community aware of their HIV+ status but not receiving treatment. A potentially transformative novel strategy to address this problem is by targeting interventions toward social networks of PLH in the community-particularly those not presently in care-to strengthen and reinforce network-level norms, readiness, skills, and plans for treatment entry, maintenance, and adherence. The approach is novel because it creates norms within the PLH community itself to motivate treatment engagement. This study will be conducted in St. Petersburg, Russia, where contemporary HAART regimens have only recently been rolled out but a high proportion of PLH are not in care, decline prescribed HAART therapy, or interrupt treatment. UNAIDS data show that the proportion of PLH in Eastern Europe outside of medical care is higher than in Subsaharan Africa, and two-thirds of PLH receiving HAART do not adhere at optimal levels. Our pilot research has established that PLH have many other PLH in their social networks, and that these networks can be identified and engaged in behavioral intervention. A 6- month period of formative study will be undertaken to tailor recruitment and intervention methods. The study's main trial will recruit 32 3-ring sociocentric social networks of PLH (n=448). Baseline assessments will be made of each participant's CD4+ and HIV viral load, care engagement, HAART adherence, and psychosocial characteristics. Networks will be randomized in equal numbers to two study conditions. Comparison condition network members will receive a care motivational interview at baseline and then usual services. Members of each of the 16 social networks assigned to the intervention condition will receive the same motivational interview session to "prime" interest in care. Then, socially influential network leaders, identified based o sociometric standing and centrality in the network's structure, will be trained to deliver ongoing theory-based, personally-tailored advice and counseling to other PLH network members over a 2-month period. Leaders will emphasize the benefits of entering, remaining, and adhering to treatment. The network intervention's aim is to boost the proportion of network members engaged in medical care, increase care attendance, reduce viral load, and improve treatment adherence at 6- and 12-month followup. We will examine how network structural characteristics mediate intervention effects, and will also model intervention impact for reducing subsequent incidence. The study's impact rests on the potential for network interventions to engage PLH in the community to enter and adhere to care. The modality will be applicable to international settings and in the United States.