Masivukeni: A Multimedia ART Adherence Intervention for Resource-Limited Settings

Masivukeni：针对资源有限环境的多媒体 ART 依从干预

基本信息

批准号：
8664431
负责人：
ROBERT H REMIEN
金额：
$ 56.27万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-08-04 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8664431
关键词：
Address Adherence Affect Africa South of the Sahara African Alcohol or Other Drugs use Behavioral Biological CD4 Lymphocyte Count Caring Cities Clinic Clinical Collaborations Communities Complex Computers Counseling Country Couples Data Disadvantaged Disease Drug resistance Educational process of instructing Electronics Goals Grant Guideline Adherence HIV HIV Infections Health Health Policy Health Services Accessibility Healthcare Human Resources Imagery Individual Informal Social Control Institutes Intervention Life Maintenance Mediating Medical Mental Health Mental disorders Modality Modeling Monitor Multimedia National Institute of Mental Health Nurses Outcome Outpatients Participant Patient Care Patients Physicians Pilot Projects Policy Maker Poverty Prevalence Problem Solving Professional counselor Provider Public Health Randomized Randomized Controlled Trials Regulation Reporting Research Research Infrastructure Research Methodology Resistance Resources Risk Science Services Social support South Africa Standardization Supervision Technology Testing Time Training Treatment Efficacy Treatment Failure Universities Viral Viral Load result Work antiretroviral therapy arm base clinical care community based participatory research contextual factors coping efficacy testing improved innovation literacy medication compliance meetings prevent primary outcome resistance factors screening secondary outcome skills social standard care success theories therapy adherence transmission process

项目摘要

DESCRIPTION (provided by applicant): South Africa (SA) has the largest number of HIV infections in the world. Although initial reports suggested that rates of ART adherence in sub-Saharan Africa were high, recent data indicate that adherence may be a major obstacle to actualizing the full benefits of ART. Inadequate adherence and associated drug resistance are factors contributing to high rates of treatment failure often observed within the first 12 months of ART initiation. Patient understanding of HIV disease and the necessity for high ART adherence, as well as the social support for maintenance of adherence are key to the long-term success of ART. Given the ratio of physicians/nurses to patients, ART adherence counseling in SA is conducted mostly by lay counselors with varied expertise and skills, and minimal supervision. Lack of standardization and variability in quality of counseling has prompted urgent calls for an effective adherence intervention that can be delivered by trained lay staff (with fidelity) to establish optimal adherence among patients initiating ART. With the support of an NIMH R34 grant, we developed Masivukeni, an innovative, multi-media computer-based intervention developed by our US-SA research team with SA patients and care providers using community based participatory research methods. Based on Social Action Theory, Masivukeni addresses contextual factors that may promote or impede adherence, and self-regulation and social support factors that can improve behavioral and biological outcomes. The utilization of computer-based technology by counselors working with patients and their treatment support partners enables lay counselors with minimal training and supervision to teach complex medical information and problem-solving skills, with culturally relevant, interactive imagery. The intervention also enhances counselor capacity for screening and making referrals for mental health and substance use problems among patients initiating ART. Our pilot study demonstrated high acceptability and feasibility, as well as promising effects on key primary and secondary outcomes. Through a collaboration among City and Provincial DOHs in Cape Town, research and clinical partners in SA (University of Cape Town) and the US (HIV Center for Clinical and Behavioral Studies at NYS Psychiatric Institute/RFMH and CCNMTL at Columbia University), we propose to compare Masivukeni to "standard care" by randomly assigning 360 patients initiating ART to one of the two study conditions in two publicly financed medical clinics serving predominantly poor communities with high HIV prevalence. Patients will be followed over the course of one year. Assessments will be administered to patients at baseline, 6 months and 12 months post baseline. Through partnership with clinicians and DOH policy-makers, the intervention will be quickly available for wide-scale dissemination if shown to be efficacious. Further, an efficacious intervention of this modality could readily be culturally tailored and implemented in other regions of the world, including the US where long-term adherence remains a challenge, particularly for patients with low literacy and mental health and substance use problems.

描述（由申请人提供）：南非 (SA) 是世界上艾滋病毒感染人数最多的国家。尽管最初的报告表明撒哈拉以南非洲地区的抗逆转录病毒疗法依从率很高，但最近的数据表明，依从性可能是实现抗逆转录病毒疗法全部益处的主要障碍。依从性不足和相关耐药性是导致 ART 开始前 12 个月内治疗失败率较高的因素。患者对 HIV 疾病的了解、高 ART 依从性的必要性以及维持依从性的社会支持是 ART 长期成功的关键。考虑到医生/护士与患者的比例，南澳的 ART 依从性咨询主要由具有不同专业知识和技能的非专业咨询师进行，监督程度最低。咨询质量缺乏标准化和可变性，促使人们紧急呼吁采取有效的依从性干预措施，这种干预措施可以由经过培训的非专业工作人员（忠诚地）提供，以在开始 ART 的患者中建立最佳的依从性。在 NIMH R34 拨款的支持下，我们开发了 Masivukeni，这是一种基于计算机的创新多媒体干预措施，由我们的美国南澳研究团队与南澳患者和护理提供者使用基于社区的参与性研究方法共同开发。基于社会行动理论，Masivukeni 解决了可能促进或阻碍依从性的背景因素，以及可以改善行为和生物学结果的自我调节和社会支持因素。与患者及其治疗支持伙伴合作的咨询师利用基于计算机的技术，使非专业咨询师只需最少的培训和监督即可通过文化相关的交互式图像教授复杂的医疗信息和解决问题的技能。该干预措施还增强了咨询师对开始接受 ART 的患者进行筛查和转介心理健康和药物使用问题的能力。我们的试点研究证明了高度的可接受性和可行性，以及对关键主要和次要结果的有希望的影响。通过开普敦市和省卫生部、南澳（开普敦大学）和美国（纽约州精神病学研究所艾滋病毒临床和行为研究中心/哥伦比亚大学 RFMH 和 CCNMTL）的研究和临床合作伙伴之间的合作，我们建议将 Masivukeni 与“标准护理”进行比较，将 360 名开始 ART 的患者随机分配到两个公共资助的医疗诊所的两种研究条件之一，这些诊所主要为艾滋病毒感染率高的贫困社区提供服务。患者将接受为期一年的随访。将在基线、基线后 6 个月和 12 个月对患者进行评估。通过与临床医生和卫生部政策制定者的合作，如果证明有效，干预措施将很快得到广泛传播。此外，这种方式的有效干预可以很容易地在世界其他地区进行文化定制和实施，包括美国，长期坚持仍然是一个挑战，特别是对于识字率低、心理健康和药物滥用问题的患者而言。