Promoting Viral Suppression through the CHAMPS+ Intervention in the Deep South

尽管努力实现艾滋病规划署的95-95-95目标，但在艾滋病毒检测、抗逆转录病毒药物方面仍然存在明显不足 在越来越多的艾滋病毒(PWH)患者中坚持治疗(ART)和病毒抑制(VS)。 艾滋病毒治疗成功方面的差距在美国南部腹地尤为明显。这些 在临床医生有限的时间和美国医疗保健服务的情况下，艾滋病毒的健康结果不太理想 系统仍然支离破碎，进一步加剧了未得到充分服务的人生活中固有的挑战， 边缘群体，如威尔斯亲王医院。通过这种方式，使用 精通资源的社区卫生工作者(CHW)干部有望应对这些挑战。 然而，CHW文献中存在差距，需要进行研究以使CHW干预措施规模化 改善美国艾滋病毒护理连续体系中的巨大差距，特别是在结束艾滋病毒流行(EHE)方面 优先考虑的地点。作为回应，我们经验丰富的研究团队开发并测试了社区 卫生工作者和移动健康改善利用移动设备的病毒抑制(CHAMPS)干预 健康(MHealth)技术，以创建针对多个层次(个人、 社会和性网络，以及社区)，以提高艺术的忠诚度和VS。我们建议在我们的基础上 威尔斯亲王医院现有干预工作和对RFA-MD-23-007的直接反应的强劲初步数据 利用我们的Champs干预，将由来自四个艾滋病毒护理机构的人员在 南方腹地。Champs+干预通过mHealth平台提供，以支持威尔斯亲王进行自我管理 他们的ART疗法通过增加CHW提供的支持性风险来增加现有的Champs干预 在非抑制期间进行减少咨询(性行为和药物使用)以预防艾滋病毒 变速箱。这项拟议的研究还建立在我们的mChoice(U01PS005229)和WiseApp的基础上 (R01HS025071)研究提高艺术执着和在南方腹地的VS。建议的研究设计 有三个目的：1)让目标人群参与发展与文化相关的 拟议研究的招募材料和保留策略，2)临床疗效评估 和南方腹地干预措施的可持续性，以及3)评估区域化执行情况 由覆盖范围、有效性、采用、实施和维护框架指导的因素。 最终，这项研究将测试Champs+促进ART依从性和抑制PWH病毒载量在 阿拉巴马州、路易斯安那州(奥尔良教区)和密西西比州，美国EHE优先考虑司法管辖区。重要的是，我们的多- 组件干预针对多个级别，以解决非 抑制--一个可能对公共卫生具有重大意义的创新和有影响力的组成部分。

Despite efforts to achieve UNAIDS 95-95-95 targets, marked deficits remain in HIV testing, antiretroviral therapy (ART) adherence, and viral suppression (VS) among a growing number of persons with HIV (PWH). Gaps in HIV treatment success are particularly pronounced in the United States (US) Deep South. These suboptimal HIV health outcomes occur at a time when clinicians have limited time and the US healthcare system remains fragmented, further exacerbating the challenges inherent in the lives of underserved, marginalized groups, such as PWH. In this way, the development and evaluation of interventions using a resource-savvy cadre of community health workers (CHW) holds promise for addressing these challenges. Yet, gaps exist in the CHW literature, and research is needed to bring CHW interventions to scale to ameliorate the large gaps in the US HIV Care Continuum, particularly in Ending the HIV Epidemic (EHE) priority locations. In response, our highly experienced study team has developed and tested the Community Health Workers And MHealth to ImProve Viral Suppression (CHAMPS) intervention which leverages mobile health (mHealth) technology to create a multi-component intervention that targets multiple levels (individual, social and sexual networks, and community) to improve ART adherence and VS. We propose to build on our strong preliminary data of extant intervention work in PWH and directly respond to RFA-MD-23-007 by leveraging our CHAMPS intervention which will be delivered by personnel from four HIV care settings in the Deep South. The CHAMPS+ intervention is delivered via an mHealth platform to support PWH to self-manage their ART regimens and adds to the extant CHAMPS intervention by adding a CHW-delivered supportive risk reduction counseling (sexual behavior and substance use) during periods of non-suppression to prevent HIV transmission. This proposed study also builds upon our mChoice (U01PS005229) and WiseApp (R01HS025071) studies to improve ART adherence and VS in the Deep South. The proposed study design has a three-fold purpose of: 1) engaging the target population in the development of culturally relevant recruitment materials and retention strategies for the proposed study, 2) assessing the clinical effectiveness and sustainability of the intervention in Deep South settings, and 3) evaluating regionalized implementation factors guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Ultimately, this study will test CHAMPS+ to promote ART adherence and suppressed viral load for PWH in in Alabama, Louisiana (Orleans Parish), and Mississippi, US EHE prioritized jurisdictions. Importantly, our multi- component intervention targets multiple levels to address HIV risk behaviors during periods of non- suppression--an innovative and impactful component likely to be of great public health import.