Testing a Multi-Component Intervention to Improve Health Outcomes and Quality of Life among Rural Older Adults Living with HIV

在美国，超过55,000名艾滋病毒(PLH)携带者生活在农村地区，超过2,300名农村患者 居民每年都被诊断出感染了艾滋病毒。与居住在农村的PLH相比，PLH的死亡率更高 与非农村的公共卫生部门合作。与非农村人相比，农村公共卫生机构被诊断出感染艾滋病毒的阶段更晚 和以后的医疗护理，使他们更有可能面临合并症和需要复杂的医疗 关心。农村公共卫生机构也比城市人员更不可能继续从事艾滋病毒护理工作，也不太可能 病毒被抑制了。与较年轻的公屋相比，较年长的公屋可能会面对额外的挑战，以维持其 健康和福祉，以及同样生活在农村地区的老年人面临着双重挑战的前景 在生活在农村环境的同时，坚持艾滋病毒护理和管理医疗条件。一些 旨在增加室性早搏抑制和改善健康相关生活质量(HRQOL)的干预措施 农村老旧的PLH。我们之前对全国农村老年PLH(N=476)的定性和调查研究 查明社会支持低、与艾滋病毒有关的耻辱、缺乏技术机会和结构性障碍(例如 住房、食品、交通和保险方面的困难)是参与艾滋病毒护理的关键预测因素 负荷(VL)抑制，以及该人群的HRQOL。在此工作的基础上，我们建议开发一个 运用多阶段优化策略(MOST)对农村老年PLH进行优化干预。我们将评估 四个干预组成部分，改编自循证干预，并远程提供： (1)辅导员促成的同伴社会支持，(2)减少艾滋病毒污名，(3)以优势为基础的病例管理， (4)个性化定制技术使用优化。我们将通过以下方式在全国招募400名农村老年PLH 与社区机构和在线广告的伙伴关系，重点是生活在 美国卫生与公众服务部的“结束艾滋病毒流行”(Ethe)计划将各州列为优先事项。在基线调查之后 (通过在线、邮寄或电话完成)和艾滋病毒VL检测(通过自采集的干血斑样本)， 参与者将被随机接受或不接受四个干预成分中的每一个 部分析因设计。随访调查将在3、6和12个月进行，VL测试将在6和12个月进行 月份。调查将评估HRQOL、护理投入、心理健康、协变量和假设 媒介(例如，社会支持、艾滋病毒污名、自我效能、电子健康素养)。主要结果是VL 抑郁和HRQOL，次要结果是参与护理和抑郁症状。排队 在MOST框架下，将评估每个组件对VL和HRQOL的影响，并优化 已确定干预措施。我们还将评估与以下各项相关的信息：可接受性、可行性和成本 干预组件。我们假设各组成部分将增加(1)参与者的比例 有室性心动过速抑制和(2)HRQOL。这项研究的结果将为我们提供改善健康的工具 农村老年PLH的结果，并推进在美国消除艾滋病毒传播的ethe计划。

More than 55,000 people living with HIV (PLH) in the US live in rural areas, and more than 2,300 rural residents are diagnosed with HIV each year. PLH who live in rural areas have higher mortality rates compared with non-rural PLH. Rural PLH are diagnosed with HIV at a more advanced stage than non-rural individuals and present for medical care later, making them more likely to face comorbidities and need complex medical care. Rural PLH are also less likely than their urban counterparts to remain engaged in HIV care and to be virally suppressed. Compared with younger PLH, older PLH may face additional challenges to maintaining their health and wellbeing, and older PLH who also live in rural areas face the doubly challenging prospect of maintaining adherence to HIV care and managing medical conditions while living in a rural environment. Few interventions aimed at increasing VL suppression and improving health-related quality of life (HRQOL) exist for rural older PLH. Our previous qualitative and survey research with rural older PLH nationwide (N = 476) identified low social support, HIV-related stigma, lack of technology access, and structural barriers (such as difficulties with housing, food, transportation, and insurance) as key predictors of engagement in HIV care, viral load (VL) suppression, and HRQOL for this population. Based on this work, we propose developing an optimized intervention for rural older PLH using the multiphase optimization strategy (MOST). We will evaluate four intervention components, adapted from evidence-based interventions and delivered remotely: (1) counselor-facilitated peer social support, (2) HIV stigma reduction, (3) strengths-based case management, and (4) individually-tailored technology use optimization. We will recruit 400 rural older PLH nationwide through partnerships with community agencies and online advertisements, with an emphasis on persons living in the states prioritized in the US HHS’ “Ending the HIV Epidemic” (EtHE) plan. Following baseline surveys (completed online, by mail, or by phone) and HIV VL testing (via self-collected dried blood spot samples), participants will be randomized to receive or not receive each of the four intervention components in a fractional factorial design. Follow-up surveys will occur at 3, 6, and 12 months, and VL testing at 6 and 12 months. Surveys will assess HRQOL, engagement in care, mental health, covariates, and hypothesized mediators (e.g., social support, HIV stigma, self-efficacy, eHealth literacy). Primary outcomes are VL suppression and HRQOL, and secondary outcomes are engagement in care and depressive symptoms. In line with the MOST framework, each component’s impact on VL and HRQOL will be evaluated, and an optimized intervention identified. We will also assess information related to the acceptability, feasibility, and cost of intervention components. We hypothesize that components will increase (1) the proportion of participants that have VL suppression and (2) HRQOL. Results from this study will provide us with tools to improve health outcomes for rural older PLH and to advance the EtHE plan to eliminate HIV transmission in the US.