Intervention to Increase Timely Initiation of HAART Among Those Who Delay/Decline

描述（由申请人提供）：本研究探讨HIV/AIDS治疗中的种族差异。在美国，许多艾滋病毒/艾滋病（PLHA）感染者（10-19%），主要是有色人种，直到艾滋病毒疾病晚期才开始接受高效抗逆转录病毒疗法（HAART），或者在医学上有指示时从未开始进行HAART治疗。与接受HAART治疗的人群相比，这一人群的发病率和早期死亡率更高，卫生保健费用更高，并且实现病毒学抑制（增加艾滋病毒传播给他人的可能性）的可能性更小。然而，我们没有行为干预来增加该组患者及时开始和持续使用HAART。该建议旨在开发一种可持续的、灵活的、个性化的基于视频的干预措施，以激励和准备个人发起和继续HAART，针对人群遇到的具体障碍。我们将医学上有资格接受HAART但延迟或拒绝HAART的PLHA- dd人群称为“PLHA- dd”。拟议的干预措施是对依从性干预措施的补充，PLHA-DD在启动HAART时可以从中受益。干预措施将针对以非裔美国人和拉丁裔为主的PLHA-DD患者在接受HAART治疗时遇到的多层次障碍进行调整。这些障碍包括个人因素（如恐惧、不信任、低自我效能、竞争优先事项）、社会因素（如消极的同伴健康规范、耻辱）和结构层面的影响（如获取）。在三重影响理论（一种多层次的社会认知理论）和反种族主义立场的指导下，干预期将持续12周，由三个单独的会议（总时间为3.5小时）和患者导航组成，这是一种低门槛，支持性和适应性强的方法，用于减少卫生保健系统障碍，其强度将取决于参与者的需求。干预会议将包括有针对性的视频和个性化的互动组件。为了减少社会障碍，干预将包括一个“支持伙伴”。启动HAART疗法的社会心理和医疗方面将密切结合起来。这个为期三年的项目的目的是：(1)探索提供者和PLHA-DD对启动/继续HAART的障碍的看法；(2)制定干预措施的组成部分，并检查其可接受性、安全性、可行性，并收集有关HAART开始/继续的初步有效性证据。为了实现这些目标，我们提出了一个三个阶段的研究：(1)启发，研究提供者（N=18）和PLHA-DD （N=16）的观点；(2)开发，创建干预组件；(3)评估，测试和修改干预成分（N=80名PLHA-DD； 50%非裔美国人，50%拉丁裔/西班牙裔从两个大型艾滋病毒诊所招募）。拟议的研究是创新的，因为它试图扩大HAART依从性研究范式，包括HAART起始。尽管PLHA-DD在人群中所占比例不大，但有效的干预措施可以降低PLHA-DD患者的发病率、延长寿命、降低医疗成本和增加病毒载量抑制，具有很高的公共卫生意义。

DESCRIPTION (provided by applicant): This study addresses racial/ethnic disparities in HIV/AIDS treatment. Many persons living with HIV/AIDS (PLHA) in the US (10-19%), predominantly people of color, delay taking Highly Active Antiretroviral Therapy (HAART) until late in their HIV disease or never initiate HAART when it is medically indicated. This population experiences higher morbidity and early mortality, higher health care costs, and is less likely to achieve virologic suppression (increasing the probability of HIV transmission to others) compared to those taking HAART. However, we do not have a behavioral intervention to increase the timely initiation and continued use of HAART in this group. This proposal seeks to develop a sustainable, flexible, and individualized video-based intervention to motivate and prepare individuals to initiate and continue HAART, targeted to the specific barriers experienced by the population. We refer to this population of PLHA medically eligible for HAART but who have delayed or declined HAART as "PLHA-DD." The proposed intervention is a complement to adherence interventions, from which PLHA-DD can benefit when they initiate HAART. The intervention will be tailored to address the multi-level barriers to HAART experienced by PLHA-DD, who are predominantly African-American and Latino. These barriers include individual- (e.g., fear, mistrust, low self efficacy, competing priorities), social- (e.g. negative peer health norms, stigma), and structural-level influences (e.g., access). Guided by the Theory of Triadic Influence, a multi-level social-cognitive theory, and the Anti-racist Stance, the intervention period will last 12 weeks and be made up of three individual sessions (3.5 hours total time) and patient navigation, a low-threshold, supportive, and adaptable approach for reducing health care system barriers, the intensity of which will depend on the participant's needs. Intervention sessions will consist of targeted video and individualized interactive components. To reduce social barriers, the intervention will include a "support partner." Psychosocial and medical aspects of HAART initiation will be closely integrated. The aims of this three-year project are to: (1) explore providers' and PLHA-DD's perspectives on barriers to initiation/continuation of HAART; and (2) develop components of an intervention and examine their acceptability, safety, feasibility, and gather preliminary evidence of efficacy with respect to HAART initiation/continuation. To accomplish these aims, we propose a three phase study: (1) Elicitation, to study the perspectives of providers (N=18) and PLHA-DD (N=16); (2) Development, to create intervention components; and (3) Evaluation, to test and revise intervention components (N=80 PLHA-DD; 50% African-American, 50% Latino/Hispanic recruited from two large HIV clinics). The proposed study is innovative in that it seeks to broaden the HAART adherence research paradigm to include HAART initiation. Although PLHA-DD are a modest proportion of the population, effective interventions to reduce morbidity, increase longevity, reduce health care costs, and increase viral load suppression among PLHA-DD have high public health significance.