ART Adherence and Secondary Prevention of HIV

ART 依从性和 HIV 二级预防

• 批准号: 8658134
• 负责人: NANCY M PETRY
• 金额: $ 66.33万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8658134
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Alcohol or Other Drugs use; Anti-Retroviral Agents; Behavior; Behavioral; Behavioral Sciences; Caring; Cellular Phone; Clinic; Cognitive deficits; Communicable Diseases; Communication; Communities; Data; Drug resistance; Drug usage; Effectiveness of Interventions; Exhibits; Goals; HIV; HIV Seropositivity; HIV drug resistance; Health; Individual; Information Management; Ingestion; Intervention; Measures; Meta-Analysis; Methods; Monitor; Outcome; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Prevention; Psychological reinforcement; Psychologist; Quality of life; Randomized; Relative (related person); Risk Behaviors; Science; Secondary Prevention; Self Efficacy; Specialist; Substance Use Disorder; Symptoms; Techniques; Technology; Time; Viral Load result; Vulnerable Populations; antiretroviral therapy; base; behavioral/social science; clinical practice; contingency management; cost; cost effectiveness; depressive symptoms; effective intervention; follow-up; high risk; improved; indexing; intervention effect; intravenous drug use; medication compliance; multidisciplinary; new technology; novel; prevent; primary outcome; psychosocial; reinforcer; resistant strain; social science research; standard care; success; transmission process; treatment duration

DESCRIPTION (provided by applicant): ART adherence and secondary prevention of HIV Anti-retroviral medications (ART) prevent the progression of HIV. However, substantial proportions of HIV positive individuals fail to adhere adequately to ART, resulting in spread of potentially drug-resistant strains to the community. A low cost method to boost ART adherence and thereby reduce the spread of HIV involves cell phone reminders, and our preliminary study (Hardy et al., 2011) finds significant effects of cell phone reminders for improving adherence. Contingency management (CM) also shows promise for improving ART adherence. CM involves providing tangible reinforcement each time the behavior (medication ingestion) is exhibited. Studies evaluating CM for increasing ART adherence have relied upon MEMS caps, but reinforcement of adherence via MEMS caps is done relatively infrequently and with delay, hindering its efficacy. Cell phones allow for reinforcement of adherence in real time. Because effect sizes of CM interventions are larger the more immediately the reinforcement is paired with the behavior targeted for change, integration of cell phone based reinforcement should improve adherence beyond reminders alone. Pilot data show feasibility, acceptability, and initial efficacy of cell phone administered CM using videoing recording techniques to verify medication adherence. Moreover, effective CM interventions have been shown to reduce risk behaviors in high-risk populations. In this study, we propose to randomize 165 HIV-positive patients to one of three 16-week treatment conditions: (1) standard care; (2) standard care + cell phone-based adherence reminders; or (3) standard care + cell phone-based adherence reminders and CM. In this latter condition, patients will earn reinforcement for sending in time- and date-stamped self videos of ART ingestion. Primary outcomes will include self-report measures of adherence and objective indices of viral loads, and effects will be evaluated both during the treatment period and throughout a one-year follow-up. Effects of these interventions on risk behaviors will be evaluated as well. We hypothesize that the cell phone reminder condition will improve adherence relative to standard care, and the cell phone reminder plus CM condition will have the best outcomes. We will also estimate the cost-effectiveness of these interventions. Results from this study may have widespread implications for the use of cell phones as a novel technology to improve initial adherence to ART, thereby reducing the spread of drug resistant HIV strains to the community.

描述（由申请人提供）：ART依从性和二次预防HIV抗逆转录病毒药物（ART）预防HIV的进展。但是，大量的艾滋病毒阳性个体无法充分遵守艺术，从而导致潜在的抗药性菌株向社区传播。提高艺术依从性并减少艾滋病毒的低成本方法涉及手机提醒，而我们的初步研究（Hardy等，2011）发现了手机提醒对提高依从性的重大影响。应急管理（CM）还显示出改善艺术依从性的希望。 CM涉及每次表现出行为（药物摄入）时提供切实的加强。评估CM增加艺术依从性的研究取决于MEMS帽，但是通过MEMS帽的依从性增强相对较少而延迟进行，从而阻碍了其功效。手机可以实时增强依从性。由于CM干预措施的效果大小更大，因此加固与针对变化的行为的立即较大，基于手机的增强的整合应该可以提高仅提醒的依从性。试验数据显示，使用视频记录技术来验证药物依从性，可以使用手机管理CM的可行性，可接受性和初始功效。此外，已显示有效的CM干预措施可减少高风险人群中的风险行为。 在这项研究中，我们建议将165例HIV阳性患者随机分为三个16周的治疗条件之一：（1）标准护理； （2）标准护理 +基于手机的依从性提醒；或（3）标准护理 +基于手机的依从性提醒和CM。在后一种情况下，患者将因时间和日期摄入的自我视频而获得加强。主要结果将包括依从性的自我报告措施和病毒负荷的客观指标，并将在治疗期间和整个一年的随访中评估效果。这些干预措施对风险行为的影响也将得到评估。我们假设手机提醒状况将相对于标准护理提高依从性，并且手机提醒加上CM条件将具有最好的结果。我们还将估计这些干预措施的成本效益。这项研究的结果可能对使用手机作为一种新技术的新技术具有广泛的影响，以提高对艺术的最初依从性，从而减少抗药性HIV菌株对社区的传播。