Technology Based Community Health Nursing to Improve cART Adherence and Virologic Suppression in Youth Living with HIV (TechN 2 CheckIN): A Regional Multi-site Study

人类免疫缺陷病毒(HIV)感染一直不成比例地威胁着 来自美国少数族裔社区的青少年和年轻成年人(Aya)。艾滋病毒已经演变成一种 慢性病，可以在门诊环境下通过抗逆转录病毒疗法(ART)进行管理，旨在 实现病毒学抑制和未感染个体的预期寿命相当。然而，对于阿雅来说， 与成年人相比，存在着巨大的差距，更大比例的人不知道自己的状况，更低的照顾率 ART的参与、保留、启动和维护，导致更高的病毒学非 抑制和发展后遗症，包括免疫恶化和传播。 旨在改善青年艾滋病毒携带者(YLHIV)结局的干预措施由 包括疾病控制和预防中心和国家卫生研究院在内的机构， 然而，大多数针对的是连续护理的早期组成部分(识别、联系和ART 入会)。我们来自HIV研究网络的研究表明，30%-40%的YLHIV不是病毒学上的 尽管处于护理中，但仍受到抑制，强调需要针对远端组件的新干预措施 护理连续体的一部分。社区卫生护士(CHN)的干预措施已被证明可以增加获得 适当利用资源，提高卫生保健利用率，促进阿亚人的降低风险行为。使用 短消息服务(SMS)的消息传递可以通过以下方式进一步增强临床护理： 就诊、服药依从性以及与医疗团队的沟通。我们已经用了这两个 低收入人群青少年复杂性性传播感染(STI)的随机试验模式 少数民族社区在阿亚及其家人中具有很高的可行性和可接受性，值得注意 改善就诊完成率、服药依从性和减少复发性传播感染。最重要的是 该项目的目标是以这项试验的证据为基础，重新调整对YLHIV的干预目的 同样的社区，他们面临着护理和用药不依从的挑战。我们的目标是比较 技术强化社区卫生护理干预(TECH-N-2签到)对老年人的影响 标准护理对照组采用随机对照试验设计。中心假设是，干预 将导致更高的抗逆转录病毒治疗和病毒学抑制的依从率。我们已经展示了我们的 跨学科团队在社区跟踪城市Aya的能力，利用CHNS和 外展工作人员根据国家标准优化护理。Tech-In 2签到计划招收120人 YLHIV在巴尔的摩-华盛顿大都会地区专门从事艾滋病毒护理的诊所进行了跟踪，他们是 挑战治疗依从性并随机让他们接受Tech-In 2签到与 关心。这项试验的结果将为参与YLHIV的最佳实践提供信息，通过解决 这一连续体对于实现难以实现的90-90-90艾滋病毒目标至关重要。

Human immunodeficiency virus (HIV) infection has disproportionately persisted as a public health threat to adolescents and young adults (AYA) from minority communities in the United States. HIV has evolved into a chronic disease, which can be managed in the outpatient setting with antiretroviral therapy (ART) designed to achieve virologic suppression and life expectancy equivalent for uninfected individuals. However, for AYA, huge disparities exist compared to adults, with greater proportions unaware of their status, lower rates of care engagement, retention, and initiation and maintenance of ART, resulting in higher rates of virologic non- suppression, and development of sequelae including immunologic deterioration and transmission. Interventions designed to improve outcomes for youth living with HIV (YLHIV) are being sponsored by agencies including the Centers for Disease Control and Prevention and the National Institutes of Health, however, most target the early components of the continuum of care (identification, linkage, and ART initiation). Our research from the HIV Research Network shows that 30-40% of YLHIV are not virologically suppressed despite being in care, highlighting the need for novel interventions targeting the distal components of the care continuum. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources, enhance health care utilization, and promote risk-reducing behavior among AYA. Use of short messaging service (SMS) messaging can further enhance clinical care by improving attendance at medical visits, medication adherence, and communication with the health care team. We have used these two modalities in randomized trials of youth with complex sexually transmitted infections (STIs) in low-income minority communities with high feasibility and acceptability amongst AYA and their families, remarkable improvements in visit completion, medication adherence, and reduction in recurrent STIs. The overarching goal of this project is to build on the evidence from this trial and to repurpose the intervention for YLHIV in the same community who are having challenges with care and medication non-adherence. We aim to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N 2 CHECK-IN) to a standard of care control group using a randomized trial design. The central hypothesis is that the intervention will result in higher rates of adherence to ART and virologic suppression. We have demonstrated our interdisciplinary team's capacity to follow urban AYA in the community, utilizing the combination of CHNs and outreach workers to optimize care according to national standards. TECH-IN 2 CHECK-IN aims to enroll 120 YLHIV followed at clinics specializing in HIV care in the Baltimore-Washington Metropolitan area who are challenged with treatment adherence and randomizing them to receive TECH-IN 2 CHECK-IN vs. standard of care. Results of this trial will inform best practices for engaging YLHIV by addressing the distal component of the continuum, critical to achieving the elusive 90-90-90 HIV goals.