A Technology-Delivered Peer-to-Peer Support ART Adherence Intervention for HIV+ Adults

一种通过技术提供的点对点支持，针对艾滋病毒成人的 ART 依从干预

• 批准号: 8943049
• 负责人: Keith Joseph Horvath
• 金额: $ 74.29万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8943049
• 关键词: Accounting; Address; Adherence; Adoption; Adult; Alcohol or Other Drugs use; Anti-Retroviral Agents; Behavior Therapy; Behavioral; Communication; Communities; Control Groups; Counseling; Dose; Drug usage; Drug user; Excess Mortality; Guidelines; HIV; HIV Infections; HIV Seropositivity; Illicit Drugs; Incentives; Infection; Information Systems; Internet; Intervention; Life; Measures; Modeling; Monitor; Morbidity - disease rate; Motivation; New York City; Outcome; Participant; Patient Self-Report; Persons; Pharmaceutical Preparations; Pilot Projects; Probability; Process; Proliferating; Provider; Public Health; Randomized; Randomized Controlled Trials; Recruitment Activity; Reporting; Science; Sexual Partners; Social support; Technology; Testing; Time; Viral Load result; antiretroviral therapy; base; computerized; cost; effective intervention; efficacy trial; evidence base; follow-up; group intervention; implementation trial; improved; innovation; intervention effect; medication compliance; men; men who have sex with men; mortality; non-drug; novel; peer; post intervention; public health relevance; response; satisfaction; scale up; skills; social; theories; therapy adherence; tool; transmission process; treatment as usual

 DESCRIPTION (provided by applicant): Studies show substantial benefit to reduce morbidity and excess mortality for people living with HIV (PLWH) who adhere to antiretroviral therapy (ART), and to lower the probability of forward transmission to sexual partners. Despite efforts to maintain engagement of PLWH along the treatment cascade, it is estimated that only 19-25%% of PLWH and 27% of MSM in the US maintain suppressed viral load (VL). Several technology- based ART adherence interventions have demonstrated efficacy, however all have been individually delivered and have failed to leverage Web 2.0 features. While peer-to-peer social support is a recommended strategy to improve ART adherence and has enormous immediate appeal as a generalizable intervention approach, no peer-to-peer social support ART adherence interventions have been tested in a full-scale efficacy trial. The "Thrive with Me" (TWM) intervention is a technology-delivered peer-to-peer social support intervention grounded in the Information, Motivation, and Behavioral Skills (IMB) model for HIV-positive MSM. In addition to asynchronous peer-to-peer support capabilities, the TWM intervention provides participants with ART adherence self-monitoring tools, medication dose reminders, and HIV-related informational content. A pilot study of the TWM intervention demonstrated feasibility and acceptability of this approach; results showed that the TWM intervention group self-reported improvement in adherence at follow-up compared to the usual care control group, with greatest gains evident among recent drug users. Based on the encouraging findings of TWM study and the need for novel, evidence-based effective ART adherence interventions, we propose the following study aims. Primary aims (Aims 1 and 2) are to examine the efficacy of the online and mobile- enabled TWM intervention in a full-scale randomized controlled trial. HIV-positive MSM with detectable VL residing in New York City will be randomized to receive the TWM intervention or an information-only HIV/ART intervention for a 5-month period. Recruitment will be stratified by recent drug use, such that half will report recent illicit drug use. VL, validated self-reported AR adherence, and intervention utilization measures will be collected at baseline, post-intervention, and 5-, and 10-month follow up. We hypothesize that participants in the TWM intervention will demonstrate significant improvements in self-reported ART adherence and VL at each follow-up time point compared to control participants, with greatest improvements among recent drug users. Aim 3 (a secondary aim) is to examine the effects of the intervention on theory-based change processes (i.e., IMB factors and social support) for improving VL, ART adherence, and substance use outcomes. The proposal is innovative for its use of mobile and online technology as an ART adherence intervention delivery tool, and for being the first technology-delivered peer-to-peer support ART adherence intervention. The public health significance of the proposed study is that it advances ART adherence intervention for persons in greatest need of intervention and, if effective, may be quickly scaled up for dissemination.

 描述（由申请人提供）：研究表明，尽管努力维持，但坚持抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLWH）对于降低发病率和超额死亡率以及降低向前传播给性伴侣的可能性有很大的好处。由于 PLWH 参与治疗级联，估计美国只有 19-25% 的 PLWH 和 27% 的 MSM 维持基于几种技术的病毒载量 (VL) 抑制。 ART 依从性干预措施已被证明有效，但所有干预措施都是单独实施的，未能利用 Web 2.0 功能。点对点的社会支持 ART 依从性干预措施已经在全面的功效试验中进行了测试。 HIV 阳性 MSM 的动机和行为技能 (IMB) 模型除了异步同伴支持功能外，TWM 干预还为参与者提供 ART 依从性自我监控工具、药物剂量提醒和 HIV 相关信息内容。一项 TWM 干预的试点研究证明了这种方法的可行性和可接受性；结果表明，与常规护理对照组相比，TWM 干预组在随访时的依从性有所改善，其中近期吸毒者的进步最为明显。基于 TWM 研究的令人鼓舞的发现以及对新颖、基于证据的有效 ART 依从干预措施的需求，我们提出以下研究目标（目标 1 和 2）是检查在线和移动支持的 TWM 的功效。居住在纽约市且可检测到 VL 的 HIV 阳性 MSM 将被随机分配接受 TWM 干预或为期 5 个月的纯信息 HIV/ART 干预。根据最近的药物使用情况进行分层，其中一半将报告最近的非法药物使用情况、经过验证的自我报告的 AR 依从性，以及将在基线、干预后以及 5 个月和 10 个月的随访中收集干预措施利用措施。我们继续认为，与对照参与者相比，TWM 干预的参与者在每个随访时间点的自我报告的 ART 依从性和 VL 方面将表现出显着改善，其中近期吸毒者的最大改善是目标 3（次要目标）是检查。这该提案的创新之处在于它使用移动和在线技术作为 ART 依从性干预实施工具。 ，并作为第一个通过技术提供的点对点支持的 ART 依从性干预，拟议研究的公共卫生意义在于，它促进了对最需要干预的人的 ART 依从性干预，如果有效，可能会迅速扩大规模。准备好传播。