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

• 批准号: 8306720
• 负责人: Marya Gwadz
• 金额: $ 30.8万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 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/8306720
• 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

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.

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/民族差异。在美国，许多艾滋病毒/艾滋病 (PLHA) 感染者 (10-19%)（主要是有色人种）推迟接受高效抗逆转录病毒治疗 (HAART)，直至艾滋病毒疾病晚期，或者在有医学指征时从不开始使用 HAART。与接受 HAART 的人群相比，该人群的发病率和早期死亡率较高，医疗费用较高，并且实现病毒学抑制（增加将 HIV 传播给他人的可能性）的可能性较小。然而，我们没有行为干预来增加该组患者及时开始和持续使用HAART。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，以激励和准备个人启动和继续HAART，针对人群经历的特定障碍。我们将医学上符合 HAART 但延迟或拒绝 HAART 的 PLHA 人群称为“PLHA-DD”。拟议的干预措施是对依从性干预措施的补充，PLHA-DD 在开始 HAART 时可以从中受益。该干预措施将针对 PLHA-DD 所经历的 HAART 多层次障碍进行量身定制，他们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、竞争优先事项）、社会（例如消极的同伴健康规范、耻辱）和结构层面的影响（例如获取）。在三元影响理论、多层次社会认知理论和反种族主义立场的指导下，干预期将持续 12 周，由三个单独的疗程（总时间 3.5 小时）和患者导航、减少医疗保健系统障碍的低门槛、支持性和适应性方法，其强度将取决于参与者的需求。干预会议将包括有针对性的视频和个性化的互动组件。为了减少社会障碍，干预措施将包括“支持伙伴”。 HAART 启动的心理社会和医学方面将紧密结合。这个为期三年的项目的目标是： (1) 探讨提供者和 PLHA-DD 对启动/继续 HAART 障碍的看法； (2) 制定干预措施的组成部分，并检查其可接受性、安全性、可行性，并收集有关 HAART 启动/继续的有效性的初步证据。为了实现这些目标，我们建议进行三阶段研究：（1）启发，研究提供者（N=18）和 PLHA-DD（N=16）的观点； (2) 开发，创建干预组件； (3) 评估，测试和修订干预措施（N=80 PLHA-DD；50% 非洲裔美国人，50% 拉丁裔/西班牙裔，从两个大型 HIV 诊所招募）。拟议的研究具有创新性，因为它寻求扩大 HAART 依从性研究范式，将 HAART 启动纳入其中。尽管 PLHA-DD 在人口中所占比例不大，但降低 PLHA-DD 发病率、延长寿命、降低医疗费用和增强病毒载量抑制的有效干预措施具有很高的公共卫生意义。