CVCTPlus: A Couples-Based Approach to Linkage to Care and ARV Adherence

描述(由申请人提供)：男男性行为者(MSM)仍然是美国艾滋病毒流行中受影响最严重的风险群体。研究表明，男男性接触者中的大多数艾滋病毒感染事件可归因于与主要男性性伴侣的性行为；然而，缺乏针对男性-男性伴侣的艾滋病毒预防干预措施。正因为如此，夫妻艾滋病毒自愿咨询和检测(CVCT)--一种反复被证明可以减少异性伴侣中艾滋病毒传播的干预措施--已被适应于美国男男性接触者夫妇。此外，新的证据表明，抗逆转录病毒疗法(ART)不仅降低了艾滋病毒阳性者的发病率和死亡率，还有助于将艾滋病毒传播给阴性伴侣的风险降低96%。由于对抗逆转录病毒疗法的依从性是可以改变的，而且同伴支持的水平已被证明可以增加抗逆转录病毒疗法的依从性，这项研究建议使用CVCT和二元依从性咨询(“CVTCPlus”)来改善艾滋病毒血清不一致的男性-男性夫妇之间的护理联系、护理中的保留、对ART的依从性和病毒抑制，使用亚特兰大、波士顿和芝加哥的250对血清不一致的夫妇。对血清不协调的夫妇(每只胳膊125人)将进行为期两年的跟踪调查，每六个月进行一次学习访问。在每次访问中，艾滋病毒阴性的伴侣将接受艾滋病毒检测，双方将完成一项研究调查，衡量可能影响坚持的社会和行为因素，例如夫妇的应对能力和他们对外部性伴侣协议的一致性，EMR提取将用于确定护理和病毒抑制方面的联系和保留。此外，接受干预的夫妇将接受特定于ART依从性实时监测提供的数据的依从性咨询(通过Wisepill)。研究人员假设，这种以夫妇为基础的二元依从性干预将有助于增加ART依从性、联动和护理中的保留，以及实现病毒抑制。了解与血清不一致男性夫妇向病毒抑制进展有关的因素，以及旨在增加联系、保留和遵守抗逆转录病毒药物的干预措施的有效性，对于制定和推出以夫妇为重点的艾滋病毒预防工作至关重要。

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) continue to be the most heavily-impacted risk group in the US HIV epidemic. Studies suggest that the majority of incident HIV infections among MSM are attributable to sex with a main male sex partner; however, HIV prevention interventions that target male-male couples are lacking. Because of this, Couples HIV Voluntary Counseling and Testing (CVCT), an intervention that has been repeatedly shown to reduce HIV transmission within heterosexual couples, has been adapted to US MSM couples. Additionally, novel evidence demonstrates that antiretroviral therapy (ART) not only reduces morbidity and mortality among HIV-positive persons, but also serves to reduce the risk of HIV transmission to a negative partner by 96%. As adherence to ART is modifiable, and levels of peer support have been shown to increase ART adherence, this current study proposes to use CVCT combined with dyadic adherence counseling ("CVTCPlus") to improve linkage to care, retention in care, ART adherence and viral suppression among HIV- sero-discordant male-male couples using a cohort of 250 serodiscordant couples in Atlanta, Boston, and Chicago. Sero-discordant couples (125 in each arm) will be followed for two years, with study visits every six months. At each visit, the HIV-negative partner will be tested for HIV and both partners will complete a study survey measuring social and behavioral factors that may influence adherence, such as a couple's coping ability and their concordance of agreements regarding outside sex partners, and EMR extraction will be used to identify linkage and retention in care and viral suppression. Additionally, couples in the intervention arm will receive adherence counseling specific to data provided by real-time monitoring of ART adherence (via Wisepill). The researchers hypothesize such a couples-based, dyadic adherence intervention will serve to increase ART adherence, linkage and retention in care, and achievement of viral suppression. Understanding of the factors associated with progression towards viral suppression among sero-discordant male couples, and the effectiveness of an intervention aimed at increasing linkage, retention and ARV adherence is vital to inform the development and roll-out of couples'-focused HIV prevention efforts.