Reaching and Engaging Community PLH Into Care Through Their Social Networks

描述(由申请人提供)：病毒载量被抑制的艾滋病毒(PLH)携带者将其感染传播给性伴侣的可能性要小得多，这导致了ART既是治疗又是预防的概念。公共卫生规模上的治疗即预防战略的成功需要所有公共卫生保健机构中从事护理的高比例。尽管在如何将新诊断的PLH与护理联系起来方面取得了进展，但已经被诊断为艾滋病毒感染的100万美国人中，有近一半生活在社区，但目前没有接受治疗。在这500,000名PLH接受医疗护理之前，他们的健康受到威胁，以预防为主的治疗无法实现其对公共卫生的最大影响。该领域目前缺乏能够接触到社区中的出院PLH的干预策略，这是治疗级联中的一个未解决的缺口。由于PLH通常与其他艾滋病毒携带者在社会上联系在一起，社交网络方法是接触社区PLH并提供干预的一种有希望的方式。这项研究将开发和试点测试一种新的网络级社区干预措施，以提高护理参与度。混合方法研究将分两个阶段进行。最初的定性阶段将包括对大约50名从未进入护理的PLH、退出HIV医疗护理的PLH以及其他关键告密者的深入访谈。将对数据进行分析，以检查公共卫生部门的观点、动机、障碍和医疗参与的促进者；确定访问非护理公共卫生部门的环境和方式；从公共卫生部门及其利益相关者那里获得研究意见；以及量身定做干预内容。第二个研究阶段是一项小型随机概念测试先导研究，以确定网络层面干预的初步效果。将在社区招募10名无照护的男男性接触者(PLH)种子(一半是非洲裔美国男男性接触者)。每个种子都将把也是HIV+的朋友带到研究中来。当注册时，这些第一环朋友又将招募他们自己的HIV+朋友，从而产生10个2环PLH社会中心网络(预计n=120人)。参与者将在基线上接受最近的护理出勤率、CD4+和艾滋病毒病毒载量、抗逆转录病毒治疗的依从性、风险做法和心理社会特征的评估。然后，五个网络将被随机化，以接受网络干预。将对干预条件网络中的领导者进行识别、培训和指导 向PLH的朋友提供持续的、基于理论的、个人量身定做的建议，关于治疗福利以及进入、留在和坚持医疗护理的策略。我们将在6个月的随访中确定干预是否增加了网络成员的关怀参与度，这是主要结果。将检查干预对治疗依从性、病毒载量和心理社会量表的次要结果的影响。如果探索性研究产生了初步的益处证据，稍后将提议进行全面试验。将要测试的网络干预有可能接触到并吸引社区中更多的PLH进入护理，这是治疗级联中的一个关键但被忽视的点。

DESCRIPTION (provided by applicant): Persons living with HIV (PLH) with suppressed viral load are much less likely to transmit their infection to sexual partners, giving rise to a conceptualization of ART as both treatment and also prevention. The success of a treatment-as-prevention strategy on a public health scale requires that a high proportion of all PLH are engaged in care. Although advances are being made in how to link newly-diagnosed PLH to care, nearly half of the one million Americans already diagnosed with HIV infection are living in the community but not presently in treatment. Until these 500,000 PLH are in medical care, their health is threatened and treatment-as-prevention cannot achieve its maximum public health impact. The field presently lacks intervention strategies that can reach out-of-care PLH in the community, an unaddressed gap in the treatment cascade. Because PLH are often socially connected with other HIV+ persons, social network approaches represent a promising way to reach PLH in the community and also deliver intervention. This research will develop and pilot test a novel network-level community intervention to improve care engagement. The mixed-methods research will occur in two phases. The initial qualitative phase will include in-depth interviews with approximately 50 PLH who never entered care, PLH who dropped out of HIV medical care, and other key informants. Data will be analyzed to examine PLH views, motivations, barriers, and facilitators of medical engagement; identify settings and ways to access out-of-care PLH; elicit research input from the PLH community and its stakeholders; and tailor intervention content. The second research phase is a small randomized test-of-concept pilot study to determine preliminary efficacy of the network-level intervention. 10 out-of-care MSM PLH seeds (half African American MSM) will be recruited in the community. Each seed will bring into the study friends known to also by HIV+. When enrolled, these first-ring friends will, in turn, also recruit their own HIV+ friends, resulting in the accrual of 10 2-ring PLH sociocentric networks (expected n=120 individuals). Participants will be assessed at baseline for recent care attendance, CD4+ and HIV viral load, ART adherence, risk practices, and psychosocial characteristics. Five networks will then be randomized to receive the network intervention. Leaders in intervention condition networks will be identified, trained, and guided to deliver ongoing, theory-based, personally tailored advice to PLH friends about treatment benefits and about strategies to enter, remain, and adhere to medical care. We will determine if the intervention increases network member care engagement at 6-month follow up, the primary outcome. Effects of intervention on secondary outcomes of treatment adherence, viral load, and psychosocial scales will be examined. If the exploratory study produces preliminary evidence of benefit, a full-scale trial will later be proposed. The network intervention to be tested has the potential to reach and engage more PLH in the community to enter care, a critical but neglected point in the treatment cascade.