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）：患有艾滋病毒（PLH）的人（PLH）受抑制病毒负荷的人将感染传播给性伴侣的可能性要小得多，从而引起艺术概念化作为治疗和预防。在公共卫生范围内进行治疗策略的成功要求，所有PLH的一部分很大一部分都从事护理。尽管如何将新诊断的PLH与护理联系起来，但正在取得进展，但在已经诊断出患有艾滋病毒感染的一百万美国人中，有将近一半居住在社区中，但目前不在治疗中。在这500,000 PLH从事医疗服务之前，他们的健康受到威胁，预防治疗将无法实现其最大的公共卫生影响。目前，该领域缺乏可以在社区中达到护理外PLH的干预策略，这是治疗级联的差距。由于PLH通常与其他艾滋病毒+人有社会联系，因此社交网络方法代表了在社区中到达PLH并提供干预措施的一种有希望的方法。这项研究将开发和试点测试一种新型的网络级社区干预措施，以改善护理参与度。混合方法研究将分为两个阶段。最初的定性阶段将包括与大约50个从未进入护理的PLH的深入访谈，从HIV医疗服务退出的PLH和其他关键线人。将分析数据以检查PLH观点，动机，障碍和医疗参与的促进者；识别设置和访问PRH外部PLH的方法；引起PLH社区及其利益相关者的研究意见；和裁缝干预内容。第二个研究阶段是一项小型的概念测试试验研究，以确定网络级干预的初步疗效。将在社区中招募10个临时MSM PLH种子（一半非裔美国人MSM）。每种种子都会带入艾滋病毒+众所周知的学习朋友。当入学时，这些首先的朋友将又将招募自己的艾滋病毒+朋友，从而获得10个2环PLH社会中心网络（预计n = 120个人）。将在基线上评估参与者，以了解最近出席，CD4+和HIV病毒负荷，艺术依从性，风险实践和社会心理特征。然后，将随机分配五个网络以接收网络干预。将确定，训练和指导干预条件网络中的领导者向PLH朋友提供有关治疗益处的持续，基于理论的个人量身定制的建议，以及有关进入，保留并遵守医疗服务的策略。我们将确定干预措施是否会在6个月的随访中增加网络成员的护理参与度，这是主要结果。将检查干预对治疗依从性，病毒负荷和社会心理量表的次要结果的影响。如果探索性研究产生了福利的初步证据，则将在后来提出全面试验。要测试的网络干预有可能吸引并参与社区中更多的PLH进入护理，这是治疗级联的关键但被忽视的点。