CVCTPlus: A Couples-Based Approach to Linkage to Care and ARV Adherence

CVCTPlus：一种基于夫妇的方法，将护理和抗逆转录病毒药物依从性联系起来

• 批准号: 8650296
• 负责人: Robert Garofalo
• 金额: $ 59.38万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-10 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8650296
• 关键词: AIDS prevention; Accounting; Achievement; Acquired Immunodeficiency Syndrome; Adherence; Agreement; Behavioral; Biological Assay; Boston; Caring; Centers for Disease Control and Prevention (U.S.); Chicago; Cities; Counseling; Couples; Data; Detection; Development; Diagnosis; Effectiveness; Effectiveness of Interventions; Enrollment; Epidemic; Foundations; Funding; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Heterosexuals; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Measures; Monitor; Morbidity - disease rate; National Institute of Mental Health; Persons; Prevention; Preventive Intervention; Publishing; Randomized; Reporting; Research; Research Personnel; Risk; Role; Sampling; Services; Sexual Partners; Shapes; Surveys; Testing; Time; Treatment Efficacy; United States; Viral; Viral Load result; Visit; Work; antiretroviral therapy; arm; base; care seeking; cohort; coping; improved; male; men; men who have sex with men; mortality; novel; peer; public health relevance; response; screening; sex; social; standard of care; therapy adherence; transmission process; uptake

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) continue to be the most heavily-impacted risk group in the US HIV epidemic. Studies suggest that the majority of incident HIV infections among MSM are attributable to sex with a main male sex partner; however, HIV prevention interventions that target male-male couples are lacking. Because of this, Couples HIV Voluntary Counseling and Testing (CVCT), an intervention that has been repeatedly shown to reduce HIV transmission within heterosexual couples, has been adapted to US MSM couples. Additionally, novel evidence demonstrates that antiretroviral therapy (ART) not only reduces morbidity and mortality among HIV-positive persons, but also serves to reduce the risk of HIV transmission to a negative partner by 96%. As adherence to ART is modifiable, and levels of peer support have been shown to increase ART adherence, this current study proposes to use CVCT combined with dyadic adherence counseling ("CVTCPlus") to improve linkage to care, retention in care, ART adherence and viral suppression among HIV- sero-discordant male-male couples using a cohort of 250 serodiscordant couples in Atlanta, Boston, and Chicago. Sero-discordant couples (125 in each arm) will be followed for two years, with study visits every six months. At each visit, the HIV-negative partner will be tested for HIV and both partners will complete a study survey measuring social and behavioral factors that may influence adherence, such as a couple's coping ability and their concordance of agreements regarding outside sex partners, and EMR extraction will be used to identify linkage and retention in care and viral suppression. Additionally, couples in the intervention arm will receive adherence counseling specific to data provided by real-time monitoring of ART adherence (via Wisepill). The researchers hypothesize such a couples-based, dyadic adherence intervention will serve to increase ART adherence, linkage and retention in care, and achievement of viral suppression. Understanding of the factors associated with progression towards viral suppression among sero-discordant male couples, and the effectiveness of an intervention aimed at increasing linkage, retention and ARV adherence is vital to inform the development and roll-out of couples'-focused HIV prevention efforts.

描述（由申请人提供）：男男性行为者 (MSM) 仍然是美国艾滋病毒流行中受影响最严重的风险群体。研究表明，MSM 中大多数艾滋病毒感染事件可归因于与主要男性性伴侣的性行为；然而，缺乏针对男性伴侣的艾滋病毒预防干预措施。因此，夫妻艾滋病毒自愿咨询和检测（CVCT）这一干预措施已被多次证明可以减少异性夫妇中艾滋病毒的传播，现已适用于美国的男男性行为者夫妇。此外，新证据表明，抗逆转录病毒治疗 (ART) 不仅可以降低 HIV 阳性者的发病率和死亡率，还可以将 HIV 传播给阴性伴侣的风险降低 96%。由于对 ART 的依从性是可以改变的，并且同伴支持水平已被证明可以提高 ART 依从性，因此当前的研究建议使用 CVCT 与二元依从性咨询（“CVTCPlus”）相结合，以改善与护理、保留护理、ART 依从性和治疗的联系。使用亚特兰大、波士顿和芝加哥的 250 对血清不一致的夫妇进行的队列研究，对 HIV 血清不一致的男性夫妇进行病毒抑制。血清不一致的夫妇（每组 125 例）将被跟踪两年，每六个月进行一次研究访问。每次就诊时，艾滋病毒呈阴性的伴侣都将接受艾滋病毒检测，双方都将完成一项研究调查，衡量可能影响依从性的社会和行为因素，例如夫妻的应对能力以及他们对外部性伴侣的协议一致性，以及电子病历（EMR）提取将用于确定护理和病毒抑制中的联系和保留。此外，干预组中的夫妇将接受针对实时监测 ART 依从性（通过 Wisepill）提供的数据的依从性咨询。研究人员假设，这种基于夫妻的二元依从性干预措施将有助于提高 ART 依从性、护理的联系和保留，以及实现病毒抑制。了解血清不一致的男性夫妇中与病毒抑制进展相关的因素，以及旨在增加联系、保留和抗逆转录病毒药物依从性的干预措施的有效性，对于制定和推出以夫妇为重点的艾滋病毒预防工作至关重要。