Mopati: A Pilot HIV Treatment Partner Intervention in Botswana

项目概要：博茨瓦纳是世界上艾滋病毒感染率第二高的国家。低成本、可扩展 干预措施对于支持艾滋病毒感染者坚持抗逆转录病毒治疗至关重要， 继续照顾。其中一种干预措施是使用治疗伙伴，这是艾滋病毒建议的。 全球至少20个国家的治疗指南。具体而言，若干国家的国家艾滋病毒政策， 包括博茨瓦纳，建议医疗保健提供者鼓励开始ART的患者识别 能够提供支持、陪同患者进行预约并提供药物提醒的个人。 虽然大量的工作表明社会支持在促进依从性方面的关键作用， 治疗伙伴的效果好坏参半。因此，需要研究以确定如何 可以更好地利用治疗伙伴的支持。我们的R21研究检查了 治疗伙伴。结果表明，有效的治疗伙伴不仅有助于依从性， 提供必要的非医疗支持（例如，运输、食物准备），以及有效的治疗伙伴 与其他类型的网络成员相比，更有可能是配偶或其他亲密伴侣。治疗 合作伙伴，特别是非抑制患者，要求咨询技能培训。以我们的R21为基础， 我们建议试点测试Mopati计划的效果（塞萨洛尼基语中的“合作伙伴”，塞萨洛尼基的官方语言）， 博茨瓦纳），一个多层次的干预，指导医疗保健提供者和患者有关治疗伙伴 选择，并培训治疗伙伴提供有效的支持。具体目标是：（1）发展 多层次的治疗伙伴干预，社区和医疗保健提供者利益相关者的投入， 博茨瓦纳;和（2）进行可行性，可接受性和病毒的初步效果的试点测试， 抑制多水平治疗伙伴干预。我们将招募80名艾滋病毒感染者， 在2个匹配的诊所对（共4个诊所; 20对/诊所）中， 哈博罗内，博茨瓦纳。诊所将被随机分配到标准治疗或医疗保健提供者指导 和治疗伙伴训练干预（即，所有诊所提供者都接受培训， 选择治疗伙伴，所有治疗伙伴都接受艾滋病毒治疗教育和培训， 使用非对抗性、非评判性的方式咨询患者）。我们将调查病人和治疗 在基线和基线后6个月时对伴侣进行病毒检测，并从临床记录中收集病毒载量。干预 可行性和可接受性将通过混合方法进行评估（例如，半结构化的病人访谈， 治疗伙伴和诊所工作人员;拒绝率）。我们将把结果提交给制定 博茨瓦纳国家艾滋病毒和艾滋病治疗指南。这项研究提供了一个独特的机会， 研究如何在各国的实践中改善抗逆转录病毒疗法的使用， 作为其它病症的保健（例如，糖尿病，肺结核），需要严格遵守。

PROJECT SUMMARY: Botswana has the second-highest HIV prevalence in the world. Low-cost, scalable interventions are essential to support people living with HIV to adhere to antiretroviral treatment (ART) and remain in care. One such intervention is the use of treatment partners, which are recommended by HIV treatment guidelines in at least 20 countries worldwide. Specifically, national HIV policies of several countries, including Botswana, recommend that healthcare providers encourage patients initiating ART to identify an individual who can provide support, accompany patients to appointments, and provide medication reminders. Although a large body of work indicates the key role of social support in promoting adherence, research on treatment partners' effectiveness has shown mixed results. Thus, research is needed to determine how support from treatment partners can be better harnessed. Our R21 study examined optimal characteristics of treatment partners. Results indicated that effective treatment partners not only help with adherence, but also provide essential non-medical support (e.g., transport, food preparation), and that effective treatment partners are more likely to be spouses or other intimate partners than other types of network members. Treatment partners, especially of unsuppressed patients, requested counseling skills training. Using our R21 as a basis, we propose to pilot test the effects of the Mopati program (“partner” in Setswana, the official language of Botswana), a multi-level intervention that guides healthcare providers and patients about treatment partner selection, and trains treatment partners on provision of effective support. The Specific Aims are: (1) To develop a multi-level treatment partner intervention with input from community and healthcare provider stakeholders in Botswana; and (2) To conduct a pilot test of the feasibility, acceptability, and preliminary effects on viral suppression of a multi-level treatment partner intervention. We will recruit 80 people living with HIV who are not virally suppressed and their 80 treatment partners in 2 matched clinic pairs (4 clinics total; 20 dyads/clinic) in Gaborone, Botswana. Clinics will be randomly assigned to standard of care or a healthcare provider guidance and treatment partner training intervention (i.e., all clinic providers receive training on advising patients about treatment partner selection, and all treatment partners receive HIV treatment education and training on counseling patients using a non-confrontational, non-judgmental style). We will survey patients and treatment partners at baseline and 6-months post-baseline and collect viral load from clinic records. Intervention feasibility and acceptability will be assessed via mixed methods (e.g., semi-structured interviews with patients, treatment partners, and clinic staff; refusal rates). We will present results to the committee that develops the Botswana National HIV and AIDS Treatment Guidelines. This research presents a unique opportunity to examine ways to improve ART use in practice across countries and has relevance for both HIV- care as well as healthcare for other conditions (e.g., diabetes, tuberculosis) that require strict adherence.