Intervention to Increase Timely Initiation of HAART Among Those Who Delay/Decline

促进延迟/拒绝接受 HAART 治疗的患者及时进行干预

基本信息

批准号：
8220492
负责人：
Marya Gwadz
金额：
$ 19.25万
依托单位：
NEW YORK UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-07-25 至 2014-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8220492
关键词：
AIDS/HIV problem Address Adherence African American Alcohol or Other Drugs use Attitude Behavior Therapy Clinic Color Communities Complement Data Development Discrimination Disease Ethnic Origin Evaluation Exclusion Fright Future HIV Health Health Care Costs Health Personnel Healthcare Healthcare Systems Highly Active Antiretroviral Therapy Hispanics Hour Individual Intervention Interview Knowledge Latino Lead Life Link Literature Longevity Maps Medical Mental Health Minority Groups Morbidity - disease rate Motivation Participant Patients Persons Pharmaceutical Preparations Phase Population Primary Health Care Probability Provider Public Health Race Readiness Recruitment Activity Research Resources Safety Self Efficacy Services Social Work Stigmata Stress Structure Testing Theoretical model Time Transportation Viral Load result Vulnerable Populations arm base behavior change effective intervention experience flexibility innovation medically necessary care mortality peer phase 1 study programs psychosocial racial and ethnic disparities social social cognitive theory social stigma theories therapy adherence transmission process

项目摘要

DESCRIPTION (provided by applicant): This study addresses racial/ethnic disparities in HIV/AIDS treatment. Many persons living with HIV/AIDS (PLHA) in the US (10-19%), predominantly people of color, delay taking Highly Active Antiretroviral Therapy (HAART) until late in their HIV disease or never initiate HAART when it is medically indicated. This population experiences higher morbidity and early mortality, higher health care costs, and is less likely to achieve virologic suppression (increasing the probability of HIV transmission to others) compared to those taking HAART. However, we do not have a behavioral intervention to increase the timely initiation and continued use of HAART in this group. This proposal seeks to develop a sustainable, flexible, and individualized video-based intervention to motivate and prepare individuals to initiate and continue HAART, targeted to the specific barriers experienced by the population. We refer to this population of PLHA medically eligible for HAART but who have delayed or declined HAART as "PLHA-DD." The proposed intervention is a complement to adherence interventions, from which PLHA-DD can benefit when they initiate HAART. The intervention will be tailored to address the multi-level barriers to HAART experienced by PLHA-DD, who are predominantly African-American and Latino. These barriers include individual- (e.g., fear, mistrust, low self efficacy, competing priorities), social- (e.g. negative peer health norms, stigma), and structural-level influences (e.g., access). Guided by the Theory of Triadic Influence, a multi-level social-cognitive theory, and the Anti-racist Stance, the intervention period will last 12 weeks and be made up of three individual sessions (3.5 hours total time) and patient navigation, a low-threshold, supportive, and adaptable approach for reducing health care system barriers, the intensity of which will depend on the participant's needs. Intervention sessions will consist of targeted video and individualized interactive components. To reduce social barriers, the intervention will include a "support partner." Psychosocial and medical aspects of HAART initiation will be closely integrated. The aims of this three-year project are to: (1) explore providers' and PLHA-DD's perspectives on barriers to initiation/continuation of HAART; and (2) develop components of an intervention and examine their acceptability, safety, feasibility, and gather preliminary evidence of efficacy with respect to HAART initiation/continuation. To accomplish these aims, we propose a three phase study: (1) Elicitation, to study the perspectives of providers (N=18) and PLHA-DD (N=16); (2) Development, to create intervention components; and (3) Evaluation, to test and revise intervention components (N=80 PLHA-DD; 50% African-American, 50% Latino/Hispanic recruited from two large HIV clinics). The proposed study is innovative in that it seeks to broaden the HAART adherence research paradigm to include HAART initiation. Although PLHA-DD are a modest proportion of the population, effective interventions to reduce morbidity, increase longevity, reduce health care costs, and increase viral load suppression among PLHA-DD have high public health significance. PUBLIC HEALTH RELEVANCE: This study addresses racial/ethnic disparities in HIV/AIDS treatment. Many persons living with HIV/AIDS (PLHA) in the U.S. (10-19% of PLHA), predominantly African-Americans and Latinos, delay taking Highly Active Antiretroviral Therapy (HAART) until late in the course of their HIV disease or never initiate HAART when it is medically indicated. However, there are no behavioral interventions to increase HAART initiation among PLHA who delay or decline HAART ("PLHA-DD"). The overarching aim of the proposed study is to develop a flexible, targeted, and sustainable behavioral intervention to increase HAART initiation among PLHA-DD, which, if efficacious, will lead to reductions in morbidity, early mortality, and health care costs, as well as increased viral load suppression (reducing transmission to others). Further, the study complements and primes participants for existing adherence interventions, from which PLHA-DD can benefit when they initiate HAART.

描述（由申请人提供）：本研究解决了艾滋病毒/艾滋病治疗中的种族/族裔差异。许多在美国患有艾滋病毒/艾滋病（PLHA）的人（10-19％），主要是有色人种，延迟接受高活跃的抗逆转录病毒疗法（HAART），直到在其HIV疾病中直到艾滋病毒疾病，或者在医学表明时从未引发HAART。与服用HAART相比，该人群的发病率和早期死亡率更高，较高的医疗保健成本，并且不太可能实现病毒学抑制（增加HIV向他人传播的可能性）。但是，我们没有行为干预来增加该组中HAART的及时启动和继续使用。该提案旨在开发一种可持续，灵活和个性化的基于视频的干预措施，以激励和准备个人发起和继续HAART，该干预针对人群所经历的特定障碍。我们指的是PLHA的医学上有资格获得HAART的人群，但延迟或拒绝Haart的人为“ PLHA-DD”。拟议的干预措施是对依从性干预措施的补充，PLHA-DD在启动Haart时可以从中受益。该干预措施将量身定制，以解决PLHA-DD经历的HAART的多层次障碍，Plha-DD主要是非裔美国人和拉丁裔。这些障碍包括个人（例如恐惧，不信任，低自我效能，竞争优先级），社会 - （例如负面的同伴健康规范，污名）和结构层面的影响（例如，访问）。在三合会影响理论，多层次的社会认知理论以及反种族主义的立场的指导下，干预期将持续12周，由三个单独的会议（总时间3.5小时）和患者导航，低位，支持性，支持和适应能力的方法来减少医疗保健系统障碍，以减少参与者的强度。干预会议将由有针对性的视频和个性化的交互式组件组成。为了减少社会障碍，干预将包括“支持伙伴”。 HAART启动的心理和医学方面将紧密整合。这个为期三年的项目的目的是：（1）探索提供商和PLHA-DD对HAART启动/延续的障碍的观点；（2）开发干预的组成部分，并检查其可接受性，安全性，可行性，并收集有关HAART启动/延续功效的初步证据。为了实现这些目标，我们提出了三个阶段研究：（1）启发，研究提供者的观点（n = 18）和plha-dd（n = 16）；（2）开发，创建干预组件；（3）评估，测试和修改干预组件（n = 80 plha-dd； 50％的非裔美国人，50％的拉丁裔/西班牙裔/西班牙裔从两个大型HIV诊所招募）。拟议的研究具有创新性，因为它旨在扩大Haart依从性研究范式以包括Haart的启动。尽管PLHA-DD是人口中的一部分，但有效的干预措施可以减少发病率，降低寿命，降低医疗保健成本并增加PLHA-DD的病毒负荷抑制具有很高的公共健康意义。公共卫生相关性：本研究解决了艾滋病毒/艾滋病治疗中的种族/族裔差异。许多在美国（PLHA的10-19％），主要是非裔美国人和拉丁美洲人的许多人（PLHA），延迟接受高活跃的抗逆转录病毒疗法（HAART），直到其HIV疾病后期，或者在医疗表明HAART时从未引发HAART。但是，没有行为干预措施可以增加延迟或拒绝Haart的PLHA（“ PLHA-DD”）的HAART启动。拟议研究的总体目的是开发灵活，有针对性和可持续的行为干预措施，以增加PLHA-DD之间的HAART启动，如果有效，这将导致发病率，早期死亡率和医疗保健成本的降低，并增加病毒载荷抑制（减少向其他人的传播）。此外，该研究还补充了参与者的现有依从性干预措施，PLHA-DD在启动HAART时可以从中受益。