Community-based accompaniment with supervised antiretrovirals in Lima, Peru

在秘鲁利马以社区为基础配合监督抗逆转录病毒药物

基本信息

批准号：
8071140
负责人：
SONYA S SHIN
金额：
$ 64.72万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-17 至 2014-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8071140
关键词：
Address Adherence Adoption Affect Anti-Retroviral Agents Behavior Clinical Clinical Trials Communities Complex Control Groups Cost Effectiveness Analysis Country Data Developing Countries Development Directly Observed Therapy Dose Eligibility Determination Enrollment Evaluation Failure HIV Health Heterogeneity Highly Active Antiretroviral Therapy Income Individual Intervention Life Link Mediating Methods Modeling Outcome Outcome Study Participant Patients Peru Play Population Study Poverty Publishing Randomized Controlled Trials Research Research Priority Resources Review Literature Risk Salvage Therapy Social Network Social support Stigmata Subgroup Substance abuse problem Supervision Target Populations Testing Treatment Effectiveness Treatment Efficacy United States Viral Load result Visit Vulnerable Populations Work antiretroviral therapy base cost effective cost effectiveness design experience improved innovation intervention effect member psychosocial public health relevance randomized trial scale up social capital social stigma standard care standard of care stress management therapy design treatment adherence treatment strategy

项目摘要

DESCRIPTION (provided by applicant): We propose a cluster-randomized trial to assess the impact of community-based DOT-HAART on HIV-positive individuals and community members in Lima, Peru. We will enroll individuals living in extreme poverty who are starting either first-line HAART or salvage therapy due to virologic failure. Those residing in intervention clusters will receive 12 months of DOT-HAART. We aim to 1) assess the proportion with suppressed HIV viral load at 18 and 24 months after starting HAART among those receiving community-based DOT-HAART versus the control group; 2) compare social capital among community members in DOT-HAART versus control communities; and 3) assess the cost-effectiveness of community-based DOT-HAART. Innovative aspects of this proposal include 1) a targeted intervention for the most vulnerable subgroup of individuals starting HAART (i.e. those living in extreme poverty); 2) a community- based DOT-HAART intervention designed specifically to achieve long-term efficacy; 3) cost- effectiveness analysis; and 4) assessment of the intervention effect on community-level social capital. These study components will inform how best to design and implement DOT-HAART strategies in Peru and other resource-poor settings. By offering a practical, efficacious and cost-effective model of DOT-HAART for resource-poor settings, the findings of this study could improve global efforts to achieve excellent long-term clinical outcomes among individuals on HAART. PUBLIC HEALTH RELEVANCE: Given the limited resources and magnitude of human immunodeficiency virus (HIV) treatment scale-up in resource-poor countries, cost-effective, efficacious adherence interventions for resource-poor settings are urgently needed. Despite accumulating evidence that directly observed therapy of highly active antiretroviral therapy (DOT- HAART) is effective, how best to apply DOT-HAART in resource-poor settings remains unanswered. Development of DOT-HAART interventions with long-term efficacy, refinement of target populations, and evaluation of cost-effectiveness are all scientific research priorities that are urgently needed to inform efforts to implement DOT-HAART in settings with limited resources.

描述（由申请人提供）：我们提出了一项集群随机试验，以评估基于社区的Dot-Haart对秘鲁利马的HIV阳性个人和社区成员的影响。我们将招募生活在极端贫困中的人，他们因病毒衰竭而开始一线HAART或打捞疗法。居住在干预群集中的人将获得12个月的点 - 哈特。我们的目标是1）在开始HAART的第18和24个月的抑制HIV病毒负荷的情况下，在接受社区基于社区的DOT-HAART与对照组的人中评估了比例； 2）比较Dot-Haart与控制社区的社区成员之间的社会资本； 3）评估基于社区的Dot-Haart的成本效益。该提案的创新方面包括1）对最脆弱的个人群体的有针对性干预（即生活在极端贫困中的人）； 2）专门旨在实现长期疗效的基于社区的DOT-HAART干预措施； 3）成本效益分析； 4）评估干预效果对社区级社会资本的影响。这些研究组件将为如何最好地设计和实施秘鲁和其他资源贫乏的策略。通过为Dot-Haart的实用，有效和成本效益的资源环境模型，这项研究的结果可以改善全球努力，以实现HAART个人中出色的长期临床结果。公共卫生相关性：鉴于资源贫乏国家的人类免疫缺陷病毒（HIV）治疗规模的资源有限，因此迫切需要对资源贫乏环境进行成本效益，有效的依从性干预措施。尽管积累了证据表明直接观察到高度活性抗逆转录病毒治疗（DOT-HAART）的治疗是有效的，但如何最好地在资源贫乏的环境中应用Dot-Haart仍未得到解决。开发具有长期疗效，目标人群的完善以及成本效益的评估的DOT-HAART干预措施都是科学研究的优先事项，这些优先事项迫切需要为在资源有限的环境中实施Dot-Haart的努力。