Reaching and Engaging Community PLH Into Care Through Their Social Networks

通过社交网络接触社区 PLH 并让他们参与护理

基本信息

批准号：
8991059
负责人：
Jeffrey A Kelly
金额：
$ 22.05万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-01-01 至 2017-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8991059
关键词：
AIDS prevention AIDS/HIV problem Address Adherence African American Alcohol or Other Drugs use American Anti-Retroviral Agents Awareness CD4 Lymphocyte Count Caring Characteristics Communities Counseling Data Diagnosis Disease Drops Educational Intervention Enrollment Friends Future Goals HIV HIV Infections Health Incidence Individual Infection Intervention Intervention Studies Interview Life Link Measures Mediator of activation protein Medical Methods Modality Modeling Motivation Names Newly Diagnosed Participant Persons Phase Pilot Projects Prevention Prevention strategy Process Provider Public Health Qualitative Research Randomized Recruitment Activity Research Research Methodology Risk Risk Behaviors Seeds Self Efficacy Sexual Partners Social Network Social support Source Testing Training Trust United States Unsafe Sex Viral Viral Load result Work antiretroviral therapy base care systems community intervention follow-up improved informant innovation intervention effect medical appointment member men who have sex with men neglect novel novel strategies peer peer networks peer support primary outcome psychosocial secondary outcome skills success theories therapy adherence therapy development tool treatment adherence

项目摘要

DESCRIPTION (provided by applicant): Persons living with HIV (PLH) with suppressed viral load are much less likely to transmit their infection to sexual partners, giving rise to a conceptualization of ART as both treatment and also prevention. The success of a treatment-as-prevention strategy on a public health scale requires that a high proportion of all PLH are engaged in care. Although advances are being made in how to link newly-diagnosed PLH to care, nearly half of the one million Americans already diagnosed with HIV infection are living in the community but not presently in treatment. Until these 500,000 PLH are in medical care, their health is threatened and treatment-as-prevention cannot achieve its maximum public health impact. The field presently lacks intervention strategies that can reach out-of-care PLH in the community, an unaddressed gap in the treatment cascade. Because PLH are often socially connected with other HIV+ persons, social network approaches represent a promising way to reach PLH in the community and also deliver intervention. This research will develop and pilot test a novel network-level community intervention to improve care engagement. The mixed-methods research will occur in two phases. The initial qualitative phase will include in-depth interviews with approximately 50 PLH who never entered care, PLH who dropped out of HIV medical care, and other key informants. Data will be analyzed to examine PLH views, motivations, barriers, and facilitators of medical engagement; identify settings and ways to access out-of-care PLH; elicit research input from the PLH community and its stakeholders; and tailor intervention content. The second research phase is a small randomized test-of-concept pilot study to determine preliminary efficacy of the network-level intervention. 10 out-of-care MSM PLH seeds (half African American MSM) will be recruited in the community. Each seed will bring into the study friends known to also by HIV+. When enrolled, these first-ring friends will, in turn, also recruit their own HIV+ friends, resulting in the accrual of 10 2-ring PLH sociocentric networks (expected n=120 individuals). Participants will be assessed at baseline for recent care attendance, CD4+ and HIV viral load, ART adherence, risk practices, and psychosocial characteristics. Five networks will then be randomized to receive the network intervention. Leaders in intervention condition networks will be identified, trained, and guided to deliver ongoing, theory-based, personally tailored advice to PLH friends about treatment benefits and about strategies to enter, remain, and adhere to medical care. We will determine if the intervention increases network member care engagement at 6-month follow up, the primary outcome. Effects of intervention on secondary outcomes of treatment adherence, viral load, and psychosocial scales will be examined. If the exploratory study produces preliminary evidence of benefit, a full-scale trial will later be proposed. The network intervention to be tested has the potential to reach and engage more PLH in the community to enter care, a critical but neglected point in the treatment cascade.

描述（由申请人提供）：病毒载量受到抑制的艾滋病毒感染者 (PLH) 将感染传染给性伴侣的可能性要小得多，从而产生了将 ART 视为治疗和预防的概念。在公共卫生层面上，以治疗为预防的战略要取得成功，需要所有 PLH 中有很高比例的人参与护理工作。尽管在如何将新诊断的 PLH 与护理联系起来方面正在取得进展，但已诊断出艾滋病毒感染的 100 万美国人中有近一半生活在社区，但目前尚未接受治疗。在这 50 万名 PLH 接受医疗护理之前，他们的健康受到威胁，预防为主的治疗无法实现其最大的公共卫生影响。目前，该领域缺乏能够覆盖社区中未接受护理的 PLH 的干预策略，这是治疗级联中尚未解决的一个缺口。由于 PLH 通常与其他 HIV 感染者有社会联系，因此社交网络方法代表了一种在社区中接触 PLH 并提供干预的有前途的方法。这项研究将开发并试点测试一种新颖的网络级社区干预措施，以提高护理参与度。混合方法研究将分两个阶段进行。最初的定性阶段将包括对大约 50 名从未进入护理的 PLH、退出 HIV 医疗护理的 PLH 以及其他关键信息提供者进行深入访谈。将分析数据以检查 PLH 的观点、动机、障碍和医疗参与的促进因素；确定接触非护理 PLH 的环境和方式；征求 PLH 社区及其利益相关者的研究意见；并定制干预内容。第二个研究阶段是一项小型随机概念测试试点研究，以确定网络级干预的初步效果。将在社区招募 10 名失养 MSM PLH 种子（一半是非裔美国 MSM）。每颗种子都会将已知感染艾滋病毒的朋友带入研究。注册后，这些第一环朋友也会反过来招募自己的 HIV+ 朋友，从而形成 10 个 2 环 PLH 社会中心网络（预计 n = 120 人）。将在基线上评估参与者的近期护理出勤率、CD4+ 和 HIV 病毒载量、ART 依从性、风险实践和心理社会特征。然后，五个网络将被随机分配以接受网络干预。将确定、培训和指导干预条件网络的领导者向 PLH 朋友提供持续的、基于理论的、个性化的建议，内容涉及治疗益处以及进入、继续和坚持医疗护理的策略。我们将在 6 个月的随访（主要结果）时确定干预措施是否会增加网络成员护理参与度。将检查干预措施对治疗依从性、病毒载量和社会心理量表等次要结果的影响。如果探索性研究产生了初步的益处证据，稍后将提议进行全面试验。待测试的网络干预措施有可能接触到社区中更多的 PLH，并让他们参与护理，这是治疗级联中的一个关键但被忽视的点。