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

描述（由申请人提供）：本研究讨论了HIV/AIDS治疗中的种族/民族差异。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，推迟接受高效抗逆转录病毒治疗（HAART），直到艾滋病毒疾病晚期，或者在有医学指征时从不开始HAART。与接受HAART的人群相比，该人群的发病率和早期死亡率较高，医疗保健费用较高，并且不太可能实现病毒学抑制（增加HIV传播给他人的可能性）。然而，我们没有一个行为干预，以增加及时启动和继续使用HAART在这一组。该提案旨在开发一种可持续的、灵活的和个性化的基于视频的干预措施，以激励和准备个人启动和继续HAART，针对人口遇到的具体障碍。我们将这种医学上符合HAART条件但延迟或拒绝HAART的PLHA人群称为“PLHA-DD”。“拟议的干预措施是对坚持干预措施的补充，PLHA-DD在启动HAART时可以从中受益。干预措施将针对性地解决PLHA-DD经历的HAART的多层次障碍，他们主要是非洲裔美国人和拉丁美洲人。这些障碍包括个人（例如，恐惧、不信任、低自我效能、竞争优先级）、社会-（例如，消极的同伴健康规范、耻辱）和结构水平影响（例如，访问）。在三元影响理论（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，用于减少医疗保健系统的障碍，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，干预措施将包括“支持伙伴”。“HAART启动的心理社会和医疗方面将密切结合。这个为期三年的项目的目的是：（1）探讨供应商和PLHA-DD对启动/继续HAART的障碍的观点;（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HAART启动/继续有效性的初步证据。为了实现这些目标，我们提出了一个三阶段的研究：（1）启发，研究供应商（N=18）和PLHA-DD（N=16）的观点;（2）开发，创建干预组件;（3）评估，测试和修改干预组件（N=80 PLHA-DD; 50%的非洲裔美国人，50%的拉丁美洲人/西班牙裔从两个大型艾滋病诊所招募）。拟议的研究具有创新性，因为它寻求扩大HAART依从性研究范式，将HAART启动纳入其中。虽然PLHA-DD在人群中所占比例不大，但有效干预措施降低发病率、延长寿命、降低医疗保健成本和增加PLHA-DD中的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.