Technology Based Community Health Nursing to Improve cART Adherence and Virologic Suppression in Youth Living with HIV (TechN 2 CheckIN): A Regional Multi-site Study

基于技术的社区健康护理可提高青少年 HIV 感染者的 cART 依从性和病毒学抑制 (TechN 2 CheckIN)：一项区域多中心研究

• 批准号: 9395467
• 负责人: ALLISON L AGWU
• 金额: $ 84.58万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-02 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9395467
• 关键词: Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Affect; Age; Area; Baltimore; Behavior; Behavioral; Caregivers; Caring; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chlamydia trachomatis; Chronic Disease; Clinic; Clinical; Clinical assessments; Communication; Communities; Community Health Nurse Specialist; Community Health Nursing; Complex; Continuity of Patient Care; Control Groups; Data; Deterioration; Development; Diagnosis; Disease Progression; Distal; Drug resistance; Enhancement Technology; Enrollment; Evidence based intervention; Evolution; Face; Failure; Family; Goals; HIV; HIV Infections; HIV diagnosis; Health; Healthcare Systems; Hospitalization; Immunologics; Incidence; Individual; Infection; International; Intervention; Intervention Studies; Life Expectancy; Low income; Maintenance; Medical; Medical Care Team; Modality; Modeling; Monitor; Nature; Neisseria gonorrhoeae; Nursing Services; Outcome; Outpatients; Ownership; Parents; Patients; Pelvic Inflammatory Disease; Pharmaceutical Preparations; Pharmacy facility; Protocols documentation; Provider; Public Health; Randomized; Randomized Controlled Trials; Recurrence; Research; Resources; Risk; Risk Behaviors; Self Care; Services; Sexually Transmitted Diseases; Site; Social isolation; Socioeconomic Status; Solid; Technology; United Nations; United States; United States National Institutes of Health; Viremia; Visit; Wages; Washington; Woman; Work; Youth; antiretroviral therapy; arm; base; clinical care; cognitive development; compare effectiveness; cost; cost effective; cost effectiveness; disease transmission; disorder prevention; disorder risk; effective therapy; ethnic minority population; follow-up; health care service utilization; high risk; improved; improved outcome; innovation; mHealth; medication compliance; meetings; metropolitan; minority communities; named group; novel; novel strategies; nursing intervention; outreach; premature; prevent; psychosocial; racial and ethnic; racial and ethnic disparities; randomized trial; retention rate; standard of care; therapy adherence; therapy design; transmission process; treatment adherence; trial design; virology; young adult; young man; young men who have sex with men

Human immunodeficiency virus (HIV) infection has disproportionately persisted as a public health threat to adolescents and young adults (AYA) from minority communities in the United States. HIV has evolved into a chronic disease, which can be managed in the outpatient setting with antiretroviral therapy (ART) designed to achieve virologic suppression and life expectancy equivalent for uninfected individuals. However, for AYA, huge disparities exist compared to adults, with greater proportions unaware of their status, lower rates of care engagement, retention, and initiation and maintenance of ART, resulting in higher rates of virologic non- suppression, and development of sequelae including immunologic deterioration and transmission. Interventions designed to improve outcomes for youth living with HIV (YLHIV) are being sponsored by agencies including the Centers for Disease Control and Prevention and the National Institutes of Health, however, most target the early components of the continuum of care (identification, linkage, and ART initiation). Our research from the HIV Research Network shows that 30-40% of YLHIV are not virologically suppressed despite being in care, highlighting the need for novel interventions targeting the distal components of the care continuum. Community health nurse (CHN) interventions have been shown to increase access to appropriate resources, enhance health care utilization, and promote risk-reducing behavior among AYA. Use of short messaging service (SMS) messaging can further enhance clinical care by improving attendance at medical visits, medication adherence, and communication with the health care team. We have used these two modalities in randomized trials of youth with complex sexually transmitted infections (STIs) in low-income minority communities with high feasibility and acceptability amongst AYA and their families, remarkable improvements in visit completion, medication adherence, and reduction in recurrent STIs. The overarching goal of this project is to build on the evidence from this trial and to repurpose the intervention for YLHIV in the same community who are having challenges with care and medication non-adherence. We aim to compare the effectiveness of a technology-enhanced community health nursing intervention (TECH-N 2 CHECK-IN) to a standard of care control group using a randomized trial design. The central hypothesis is that the intervention will result in higher rates of adherence to ART and virologic suppression. We have demonstrated our interdisciplinary team's capacity to follow urban AYA in the community, utilizing the combination of CHNs and outreach workers to optimize care according to national standards. TECH-IN 2 CHECK-IN aims to enroll 120 YLHIV followed at clinics specializing in HIV care in the Baltimore-Washington Metropolitan area who are challenged with treatment adherence and randomizing them to receive TECH-IN 2 CHECK-IN vs. standard of care. Results of this trial will inform best practices for engaging YLHIV by addressing the distal component of the continuum, critical to achieving the elusive 90-90-90 HIV goals.

人类免疫缺陷病毒（HIV）感染已成为公共卫生威胁的不成比例 来自美国少数民族社区的青少年和年轻人（AYA）。艾滋病毒已经演变成 慢性疾病，可以在抗逆转录病毒疗法（ART）的门诊环境中进行管理 对于未感染的个体，获得病毒学抑制和预期寿命。但是，对于Aya， 与成年人相比存在巨大的差距 参与，保留和启动和维护艺术，导致病毒学非 - 抑制和后遗症的发展，包括免疫学劣化和传播。 旨在改善艾滋病毒青年（YLHIV）的旨在改善预后的干预措施正在由 包括疾病控制与预防中心以及美国国立卫生研究院的机构， 但是，大多数针对护理连续体的早期组成部分（身份，联系和艺术 引发）。我们来自HIV研究网络的研究表明，YLHIV的30-40％在病毒学上不是 尽管受到护理的限制，但仍强调了针对远端组件的新颖干预措施的需求 护理连续性。已显示社区健康护士（CHN）干预措施可以增加对 适当的资源，促进医疗保健利用，并促进AYA之间的降低风险行为。使用 短信服务（SMS）消息传递可以通过提高出勤率进一步增强临床护理 医疗访问，药物依从性以及与医疗保健团队的沟通。我们使用了这两个 低收入性感染复杂性传播感染（STI）的随机试验的方式 Aya及其家人之间具有高可行性和可接受性的少数民族社区，非凡 访问完成，药物依从性和复发性性传播感染的降低。总体 该项目的目标是基于该试验的证据，并重新利用YLHIV的干预措施 同一个社区在护理和药物不遵守方面面临挑战。我们的目的是比较 技术增强社区健康护理干预措施（Tech-N 2签到）的有效性 使用随机试验设计的护理对照组。中心假设是干预 将导致更高的依从性对艺术和病毒学抑制。我们已经证明了我们的 跨学科团队的能力在社区中跟随城市AYA，利用CHN和 外展工人根据国家标准优化护理。 Tech-In 2入住目标旨在注册120 在巴尔的摩 - 华盛顿大都会地区专门从事艾滋病毒护理的诊所之后 通过治疗依从性挑战并将其随机挑战以接收技术登机手续与标准 关心。该试验的结果将通过解决YLHIV的最佳实践来为YLHIV参与 连续体对于实现难以捉摸的90-90-90 HIV目标至关重要。