Social Network Intervention to Engage Out-of-Care PLH Into Treatment

描述（由申请人提供）：抗逆转录病毒疗法抑制病毒载量，降低艾滋病毒感染者（PLH）将感染传染给性伴侣的可能性。 启动高效抗逆转录病毒疗法既是一种治疗，也是一种降低未来艾滋病毒发病率的策略。只有当社区中高比例的艾滋病毒携带者进入、维持和坚持护理时，以治疗为预防才能在公共卫生规模上取得成功。一个几乎没有得到科学关注的问题是，如何接触社区中大量知道自己艾滋病毒阳性但没有接受治疗的人。一个潜在的变革性的新战略，以解决这个问题是通过有针对性的干预措施对社交网络的艾滋病病毒携带者在社区，特别是那些目前没有照顾，以加强和巩固网络层面的规范，准备，技能和计划的治疗进入，维护和坚持。这种方法是新颖的，因为它在PLH社区本身建立了规范，以激励治疗参与。本研究将在俄罗斯的圣彼得堡（St.彼得堡）进行，那里的现代HAART方案最近才推出，但很大一部分PLH患者没有接受治疗，拒绝接受HAART治疗或中断治疗。联合国艾滋病规划署的数据显示，东欧没有医疗服务的艾滋病毒携带者比例高于撒哈拉以南非洲，三分之二接受高效抗逆转录病毒疗法的艾滋病毒携带者没有坚持最佳水平。我们的试点研究已经确定，PLH有许多其他PLH在他们的社交网络，这些网络可以识别和参与行为干预。将进行为期6个月的形成性研究，以调整招募和干预方法。本研究的主要试验将招募32名三环社会中心社交网络的PLH（n=448）。将对每位参与者的CD 4+和HIV病毒载量、护理参与度、HAART依从性和心理社会特征进行基线评估。将网络以相等数量随机分配至两种研究条件。比较条件网络成员将在基线接受护理动机访谈，然后接受常规服务。分配给干预条件的16个社交网络中的每一个的成员都将接受相同的激励性访谈，以“激发”对护理的兴趣。然后，社会上有影响力的网络领导者，根据社会计量学的地位和网络结构的中心地位确定，将接受培训，在2个月的时间内向其他PLH网络成员提供持续的基于理论的，个性化的建议和咨询。领导者将强调进入，保持和坚持治疗的好处。网络干预的目的是提高参与医疗保健的网络成员的比例，增加护理出勤率，减少病毒载量，并在6个月和12个月的随访中提高治疗依从性。我们将研究网络结构特征如何介导干预效果，并将模型干预的影响，以减少随后的发病率。这项研究的影响取决于网络干预的潜力，使PLH在社区进入并坚持护理。该模式将适用于国际环境和美国。

DESCRIPTION (provided by applicant): Antiretroviral therapy suppresses viral load, reducing the likelihood that persons living with HIV (PLH) will transmit their infection to sexual partners. Initiation of HAART is both treatment and also a strategy to reduce future HIV incidence. Treatment-as-prevention can only be successful on a public health scale when a high proportion of PLH in the community enter, maintain, and adhere to care. A question that has received almost no scientific attention is how to reach the large number of persons in the community aware of their HIV+ status but not receiving treatment. A potentially transformative novel strategy to address this problem is by targeting interventions toward social networks of PLH in the community-particularly those not presently in care-to strengthen and reinforce network-level norms, readiness, skills, and plans for treatment entry, maintenance, and adherence. The approach is novel because it creates norms within the PLH community itself to motivate treatment engagement. This study will be conducted in St. Petersburg, Russia, where contemporary HAART regimens have only recently been rolled out but a high proportion of PLH are not in care, decline prescribed HAART therapy, or interrupt treatment. UNAIDS data show that the proportion of PLH in Eastern Europe outside of medical care is higher than in Subsaharan Africa, and two-thirds of PLH receiving HAART do not adhere at optimal levels. Our pilot research has established that PLH have many other PLH in their social networks, and that these networks can be identified and engaged in behavioral intervention. A 6- month period of formative study will be undertaken to tailor recruitment and intervention methods. The study's main trial will recruit 32 3-ring sociocentric social networks of PLH (n=448). Baseline assessments will be made of each participant's CD4+ and HIV viral load, care engagement, HAART adherence, and psychosocial characteristics. Networks will be randomized in equal numbers to two study conditions. Comparison condition network members will receive a care motivational interview at baseline and then usual services. Members of each of the 16 social networks assigned to the intervention condition will receive the same motivational interview session to "prime" interest in care. Then, socially influential network leaders, identified based o sociometric standing and centrality in the network's structure, will be trained to deliver ongoing theory-based, personally-tailored advice and counseling to other PLH network members over a 2-month period. Leaders will emphasize the benefits of entering, remaining, and adhering to treatment. The network intervention's aim is to boost the proportion of network members engaged in medical care, increase care attendance, reduce viral load, and improve treatment adherence at 6- and 12-month followup. We will examine how network structural characteristics mediate intervention effects, and will also model intervention impact for reducing subsequent incidence. The study's impact rests on the potential for network interventions to engage PLH in the community to enter and adhere to care. The modality will be applicable to international settings and in the United States.