Increasing Social Support to Improve HIV Care Engagement and Adherence

描述（由申请人提供）：在俄罗斯，很大一部分艾滋病毒感染者（PLH）目前没有接受艾滋病毒治疗，大多数接受抗逆转录病毒治疗（ART）的PLH没有坚持达到完全抑制病毒所需的水平。这导致健康状况不佳。由于病毒抑制降低了艾滋病毒传播的可能性，护理出勤率和抗逆转录病毒疗法依从性差也增加了人口一级的艾滋病毒发病率。本申请旨在扩大美国威斯康星州医学院艾滋病干预研究中心（CAIR）的研究人员与彼得堡州立大学医学院的科学团队之间的长期、双边和跨学科合作，以开发和试点测试一种利用同伴社会支持改善ART护理参与和依从性的新型干预措施。在第一年的定性阶段，科学团队将对大约60名PLH和了解PLH社区的关键线人进行深入访谈，并分析数据。样本将包括医疗保健内外的PLH，选择代表不同的暴露风险，包括吸毒者，男男性行为者和异性恋PLH。定性阶段将确定个人层面，社会和结构因素responsibe为穷人的治疗出勤率和坚持以及资源，促进医疗保健，特别是社会支持的作用。研究的第二阶段将整合定性结果 转化为同伴社会支持干预，旨在改善护理参与和ART依从性。我们先前的研究已经确定，社区中的PLH通常聚集在他们与其他HIV阳性者的友谊群体中，这些完整的PLH友谊群体可以被招募到研究中。要测试的干预不同于传统的一对一的坚持患者咨询干预与整个PLH友谊组，以创建同伴的社会和规范的支持治疗。概念试验性干预将招募20名脱离护理或抗逆转录病毒疗法非粘附种子，以及每个种子的个人友谊组中所有愿意接受艾滋病毒检测的人（预期n=100名参与者）。在对护理参与、ART依从性、心理社会困扰、物质使用以及CD4+和病毒载量进行基线评估后，将10个PLH朋友组（n=50名参与者）随机分配至干预条件，并将10个PLH朋友组（n=50）随机分配至比较条件。处于干预条件下的每个友谊小组的所有成员将一起参加7次干预，该干预针对进入、保留和坚持艾滋病毒医疗护理的态度、意图和技能。由于参与者将参加与其他PLH谁是他们自己的朋友在日常生活中的会议，所有会议将建立和增加每个友谊组内的相互社会支持的照顾和坚持。干预结果将通过基线至6个月随访时行为和生物学指标的变化来确定。如果干预试点试验提供了干预效益的证据，我们稍后将提出一个更大规模的试验方法。

DESCRIPTION (provided by applicant): A large proportion of persons living with HIV infection (PLH) in Russia are not presently in HIV medical care and a majority of PLH on antiretroviral therapy (ART) do not adhere to their regimens at levels needed to achieve full viral suppression. This results in poor health outcomes. Because viral suppression reduces the likelihood of HIV transmission, poor care attendance and ART adherence also increase HIV disease incidence at a population level. This application proposes to expand a longstanding, bilateral, and interdisciplinary collaboration between investigators at the Center for AIDS Intervention Research (CAIR) at the Medical College of Wisconsin, USA and a scientific team at St. Petersburg State University Medical Faculty to develop and pilot test a novel intervention that harnesses peer social support to improve ART care engagement and adherence. In the first year qualitative phase, the scientific team will carry out and analyze data from in-depth interviews with approximately 60 PLH and key informants knowledgeable about the PLH community. The sample will include PLH in and out of medical care, selected to represent diverse exposure risks including drug users, men who have sex with men, and heterosexual PLH. The qualitative phase will identify individual-level, social, and structural factors responsibe for poor treatment attendance and adherence as well as resources that facilitate medical care, especially the role of social support. Phase II of the research will integrate qualitative findings into a peer social support intervention designed to improve care engagement and ART adherence. Our prior research has established that PLH in the community are often clustered in their friendship groups with other HIV+ persons and that these intact PLH friendship groups can be recruited into research. The intervention to be tested differs from traditional one-on-one adherence patient counseling by intervening with entire PLH friendship groups to create peer social and normative support for treatment. The test-of-concept pilot intervention will recruit 20 out-of-care or ART nonadherent seeds and also all willing HIV+ persons in each seed's personal friendship group (expected n=100 participants). Following baseline assessment of care engagement, ART adherence, psychosocial distress, substance use, and CD4+ and viral load, 10 of the PLH friend groups (n=50 participants) will be randomized to an intervention condition and 10 PLH friend groups (n=50) to the comparison condition. All members of each friendship group in the intervention condition will together attend a 7-session intervention that targets attitudes, intentions, and skills for entering, remaining, and adhering to HIV medical care. Because participants will attend sessions with other PLH who are their own friends in day-to-day life, all sessions will build and increase mutual social support within each friendship group for care and adherence. Intervention outcomes will be determined by baseline to 6-month followup change on behavioral and biological measures. If the intervention pilot test provides evidence of intervention benefit, we will later propose a larger scale trial of the approach.