Effect of Peer Navigation and Contingency Management on Retention in HIV Care

描述（由申请人提供）：抗逆转录病毒疗法（ART）的持续治疗可抑制病毒载量（VL），延长HIV+患者的生命并改善其生活质量。抑制VL通过减少向他人的传播而使社区受益。然而，仅仅提供抗逆转录病毒疗法和护理是不够的;抗逆转录病毒疗法的益处取决于艾滋病毒抗体阳性者不断向卫生保健提供者就诊、定期监测和定期提供药物，这被称为艾滋病毒护理的保留。尽管国家作出了努力，但仍有多达四分之一的艾滋病毒阳性者，特别是低收入少数群体，得不到护理。因此，迫切需要创新的干预措施，以最大限度地参与和保留艾滋病毒护理，自我报告的依从性，以及HIV-1 RNA病毒载量抑制。为了实现这些目标，拟议的研究将评估以下干预措施与常规护理相比的结果：1）仅应急管理（CM）; 2）仅同伴导航（PN）; 3）整合CM和PN（CA）的联合方法。 然后，将在一项充分把握度的随机对照试验（RCT）中实施和评价干预措施，该试验使用1）仅应急管理（CM）; 2）仅同行导航（PN）; 3）整合CM和PN（CA）的联合方法。 检查干预措施（CM和PN）相互比较、与其组合（CA）和常规护理的效果。将从洛杉矶县（LAC）提供HIV护理的公共资助诊所招募总计660名未充分保留的个人（165人/组）。这495项干预措施和165项对照措施将通过面谈、VL测试和艾滋病毒护理访问的电子记录审查进行评估。评估将涉及艾滋病毒护理的保留，ART药物的使用和病毒载量抑制结果，以及中间变量，如护理障碍，药物使用，心理健康，社会支持，自我效能，知识，耻辱和其他可能影响干预措施有效性的因素。我们还将评估干预的成本， 从长期干预结果中可能节省的费用（费用抵消和成本效益）。如果被证明是有效的和具有成本效益的，这项研究可能会对洛杉矶和其他主要大都市地区的个人和公共卫生产生重大而广泛的影响。

DESCRIPTION (provided by applicant): Consistent treatment with anti-retroviral therapy (ART) suppresses viral load (VL), prolonging life and improving quality of life for HIV+ persons. Suppressing VL benefits communities by reducing transmission to others. Mere availability of ART and care, however, is insufficient; the benefits of ART depend upon HIV+ persons' continuous visits to the health care provider, regular monitoring and regular delivery of medications, - known as retention in HIV care. In spite of national efforts, up to a quarter of HIV+ persons, especially low- income minorities, are out of care. Innovative interventions are therefore urgently needed to maximize engagement and retention in HIV care, self-reported adherence, as well as HIV-1 RNA viral load suppression. In pursuit of these aims, the proposed study will assess outcomes of the following interventions in comparison to usual care: 1) contingency management (CM) only; 2) peer navigation (PN) only; and 3) a combined approach that integrates both CM and PN (CA). The interventions will then be implemented and evaluated in a fully powered Randomized Control Trial (RCT) using 1) contingency management (CM) only; 2) peer navigation (PN) only; and 3) a combined approach that integrates both CM and PN (CA). to examine the effect of the interventions (CM and PN) compared to one another, to their combination (CA) and to usual care. A total of 660 inadequately retained individuals (165/group) will be recruited from publically-funded clinics providing HIV Care in Los Angeles County (LAC). These 495 intervention and 165 controls will be assessed through interviews, VL tests and electronic record review for HIV care visits. The evaluation will address retention in HIV care, use of ART medications, and viral load suppression outcomes, as well as intermediate variables, such as barriers to care, substance use, mental health, social support, self-efficacy, knowledge, stigma, and other factors that may affect the effectiveness of the intervention. We will also assess the costs of the intervention and potential cost savings from long-term intervention outcomes (cost offset and cost-effectiveness). If shown to be effective and cost-effective, this study could have substantial, widespread impact on both individual and public health in Los Angeles and other major metropolitan areas.