Social Network Intervention to Engage Out-of-Care PLH Into Treatment

社交网络干预让护理外 PLH 参与治疗

基本信息

批准号：
8650924
负责人：
Yuri A Amirkhanian
金额：
$ 56.27万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-04-15 至 2018-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8650924
关键词：
AIDS/HIV problem Acquired Immunodeficiency Syndrome Address Adherence Africa South of the Sahara Appointment Attention Attitude Awareness Behavior Therapy Build-it CD4 Lymphocyte Count Caring Characteristics Cities Communities Counseling Country Data Decision Making Development Diagnosis Eastern Europe Enrollment Epidemic Friends Future Generations HIV HIV Infections Health Highly Active Antiretroviral Therapy Incidence Individual Infection Influentials International Intervention Intervention Studies Intervention Trial Interview Laboratories Life Maintenance Measures Mediating Medical Mental Health Methods Modality Modeling Motivation Needle Sharing Outcome Participant Patients Persons Phase Positioning Attribute Prevention Primary Prevention Process Provider Public Health Randomized Readiness Recruitment Activity Regimen Research Rest Risk Behaviors Russia Schedule Seeds Services Sexual Partners Sexual Transmission Social Network Social support Source Structure Testing Training Trust USSR United States Unsafe Sex Viral Load result Work antiretroviral therapy base care systems coping disease transmission improved indexing informant innovation interest intervention effect medical appointment member mortality motivational enhancement therapy novel novel strategies peer prevent primary outcome psychosocial public health relevance secondary outcome skills standard care theories therapy design transmission process treatment adherence treatment planning uptake

项目摘要

DESCRIPTION (provided by applicant): Antiretroviral therapy suppresses viral load, reducing the likelihood that persons living with HIV (PLH) will transmit their infection to sexual partners. Initiation of HAART is both treatment and also a strategy to reduce future HIV incidence. Treatment-as-prevention can only be successful on a public health scale when a high proportion of PLH in the community enter, maintain, and adhere to care. A question that has received almost no scientific attention is how to reach the large number of persons in the community aware of their HIV+ status but not receiving treatment. A potentially transformative novel strategy to address this problem is by targeting interventions toward social networks of PLH in the community-particularly those not presently in care-to strengthen and reinforce network-level norms, readiness, skills, and plans for treatment entry, maintenance, and adherence. The approach is novel because it creates norms within the PLH community itself to motivate treatment engagement. This study will be conducted in St. Petersburg, Russia, where contemporary HAART regimens have only recently been rolled out but a high proportion of PLH are not in care, decline prescribed HAART therapy, or interrupt treatment. UNAIDS data show that the proportion of PLH in Eastern Europe outside of medical care is higher than in Subsaharan Africa, and two-thirds of PLH receiving HAART do not adhere at optimal levels. Our pilot research has established that PLH have many other PLH in their social networks, and that these networks can be identified and engaged in behavioral intervention. A 6- month period of formative study will be undertaken to tailor recruitment and intervention methods. The study's main trial will recruit 32 3-ring sociocentric social networks of PLH (n=448). Baseline assessments will be made of each participant's CD4+ and HIV viral load, care engagement, HAART adherence, and psychosocial characteristics. Networks will be randomized in equal numbers to two study conditions. Comparison condition network members will receive a care motivational interview at baseline and then usual services. Members of each of the 16 social networks assigned to the intervention condition will receive the same motivational interview session to "prime" interest in care. Then, socially influential network leaders, identified based o sociometric standing and centrality in the network's structure, will be trained to deliver ongoing theory-based, personally-tailored advice and counseling to other PLH network members over a 2-month period. Leaders will emphasize the benefits of entering, remaining, and adhering to treatment. The network intervention's aim is to boost the proportion of network members engaged in medical care, increase care attendance, reduce viral load, and improve treatment adherence at 6- and 12-month followup. We will examine how network structural characteristics mediate intervention effects, and will also model intervention impact for reducing subsequent incidence. The study's impact rests on the potential for network interventions to engage PLH in the community to enter and adhere to care. The modality will be applicable to international settings and in the United States.

描述（由申请人提供）：抗逆转录病毒疗法抑制病毒载量，减少艾滋病毒（PLH）患者将其感染传播给性伴侣的可能性。 Haart的启动既是治疗，又是减少未来HIV发病率的策略。预防治疗只有在社区中有很大比例的PLH进入，维护和遵守护理时，才能在公共卫生范围内取得成功。一个几乎没有科学关注的问题是如何接触社区中大量的人知道他们的艾滋病毒+状态，但没有接受治疗。解决此问题的潜在变革性新颖的策略是将干预措施靶向社区中PLH的社交网络，目前是那些目前尚未照顾和加强网络级别的规范，准备，准备和计划的计划，以进行治疗，维护，维护和遵守计划。这种方法是新颖的，因为它在PLH社区内部创建规范以激发治疗的参与。这项研究将在俄罗斯的圣彼得堡进行，那里直到最近才推出，但很大一部分PLH没有得到护理，下降了开处方的Haart治疗或中断治疗。联合国AIDS数据显示，东欧医疗服务以外的PLH比例高于亚巴哈兰非洲的非洲，而接受HAART的PLH中有三分之二并不遵守最佳水平。我们的试点研究已经确定，PLH在其社交网络中还有许多其他PLH，并且可以将这些网络识别并参与行为干预。将进行6个月的形成性研究，以量身定制招聘和干预方法。该研究的主要试验将招募32三环社交社交网络的PLH（n = 448）。将对每个参与者的CD4+和HIV病毒负荷，护理参与，HAART依从性和社会心理特征进行基线评估。网络将以相等的数量随机分配到两个研究条件。比较条件网络成员将在基线和通常的服务上获得护理动机面试。分配给干预条件的16个社交网络中的每个成员都将获得同样的动机面试会议，以“理想”对护理的兴趣。然后，具有社会影响力的网络领导者，确定了基于网络结构中基于O的社会计量规定和中心地位，将在2个月的时间内向其他PLH网络成员提供持续的基于理论的，个人详细的建议和咨询。领导者将强调进入，剩下和坚持治疗的好处。网络干预的目的是提高从事医疗服务的网络成员的比例，增加出勤率，减少病毒负荷并在6个月和12个月的随访中提高治疗依从性。我们将研究网络结构特征如何介导干预效果，还将模拟干预措施的影响，以减少随后的发病率。这项研究的影响取决于网络干预措施使PLH参与社区进入并坚持照顾的潜力。这种方式将适用于国际环境和美国。