Promoting Viral Suppression through the CHAMPS+ Intervention in the Deep South

通过 CHAMPS 干预南部腹地促进病毒抑制

• 批准号: 10819823
• 负责人: David S Batey
• 金额: $ 116.05万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-21 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10819823
• 关键词: Address; Adherence; Adult; Alabama; Anti-Retroviral Agents; Area; Black Populations; Caring; Cessation of life; Chronic; Clinic; Clinical assessments; Clinical effectiveness; Communities; Community Health Aides; Complex; Continuity of Patient Care; Counseling; Country; Data; Deep South; Development; Diagnosis; Disease; Disparity; Epidemic; Evaluation; Focus Groups; General Population; Geographic Locations; Geography; HIV; HIV Infections; HIV risk; HIV/AIDS; Health; Health Services Accessibility; Health Technology; Healthcare; Healthcare Systems; Human Resources; Human immunodeficiency virus test; Individual; Intervention; Intervention Trial; Life Expectancy; Literature; Location; Louisiana; Manuals; Medical; Mississippi; Mobile Health Application; Modeling; New York City; Outcome; Patient Monitoring; Persons; Population; Principal Investigator; Public Health; Randomized; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Regimen; Research; Research Design; Resources; Risk; Risk Behaviors; Risk Reduction; Rural; Sampling; Self Management; Services; Sex Behavior; Target Populations; Testing; Therapeutic; Time; Translations; Treatment Protocols; United States; Viral; Viral Load result; Work; antiretroviral therapy; clinical efficacy; community organizations; effectiveness evaluation; epidemic preparedness; ethnic minority; evidence base; experience; future implementation; health disparity; health disparity populations; health literacy; implementation determinants; improved; innovation; mHealth; marginalized population; medication compliance; men who have sex with men; multi-component intervention; premature; prevent; primary outcome; racial minority; recruit; resistance mutation; response; retention rate; scale up; secondary outcome; social; standard of care; substance use; success; therapy adherence; transgender women; transmission process

Despite efforts to achieve UNAIDS 95-95-95 targets, marked deficits remain in HIV testing, antiretroviral therapy (ART) adherence, and viral suppression (VS) among a growing number of persons with HIV (PWH). Gaps in HIV treatment success are particularly pronounced in the United States (US) Deep South. These suboptimal HIV health outcomes occur at a time when clinicians have limited time and the US healthcare system remains fragmented, further exacerbating the challenges inherent in the lives of underserved, marginalized groups, such as PWH. In this way, the development and evaluation of interventions using a resource-savvy cadre of community health workers (CHW) holds promise for addressing these challenges. Yet, gaps exist in the CHW literature, and research is needed to bring CHW interventions to scale to ameliorate the large gaps in the US HIV Care Continuum, particularly in Ending the HIV Epidemic (EHE) priority locations. In response, our highly experienced study team has developed and tested the Community Health Workers And MHealth to ImProve Viral Suppression (CHAMPS) intervention which leverages mobile health (mHealth) technology to create a multi-component intervention that targets multiple levels (individual, social and sexual networks, and community) to improve ART adherence and VS. We propose to build on our strong preliminary data of extant intervention work in PWH and directly respond to RFA-MD-23-007 by leveraging our CHAMPS intervention which will be delivered by personnel from four HIV care settings in the Deep South. The CHAMPS+ intervention is delivered via an mHealth platform to support PWH to self-manage their ART regimens and adds to the extant CHAMPS intervention by adding a CHW-delivered supportive risk reduction counseling (sexual behavior and substance use) during periods of non-suppression to prevent HIV transmission. This proposed study also builds upon our mChoice (U01PS005229) and WiseApp (R01HS025071) studies to improve ART adherence and VS in the Deep South. The proposed study design has a three-fold purpose of: 1) engaging the target population in the development of culturally relevant recruitment materials and retention strategies for the proposed study, 2) assessing the clinical effectiveness and sustainability of the intervention in Deep South settings, and 3) evaluating regionalized implementation factors guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Ultimately, this study will test CHAMPS+ to promote ART adherence and suppressed viral load for PWH in in Alabama, Louisiana (Orleans Parish), and Mississippi, US EHE prioritized jurisdictions. Importantly, our multi- component intervention targets multiple levels to address HIV risk behaviors during periods of non- suppression--an innovative and impactful component likely to be of great public health import.

尽管努力达到UNAID 95-95-95的目标，但在HIV测试中仍然有明显的缺陷，抗逆转录病毒 越来越多的艾滋病毒（PWH）的治疗（ART）依从性和病毒抑制（VS）。 艾滋病毒治疗成功的差距在美国（美国）深南部特别明显。这些 次优的HIV健康结果发生在临床医生的时间有限和美国医疗保健的时候 系统仍然分散，进一步加剧了服务不足的生活中固有的挑战 边缘化组，例如PWH。这样，使用 精通社区卫生工作者资源的干部（CHW）有望应对这些挑战。 然而，CHW文献中存在差距，需要进行研究以使CHW干预措施扩展到 改善美国艾滋病毒护理连续体的较大差距，特别是在结束HIV流行（EHE）方面 优先位置。作为回应，我们经验丰富的学习团队已经发展并测试了社区 卫生工作者和MHealth以改善利用移动的病毒抑制（Champs）干预措施 健康（MHealth）技术以创建针对多个级别（个人， 社会和性网络以及社区），以提高艺术依从性和VS。我们建议以我们的 PWH中现有干预工作的强大初步数据，并直接响应RFA-MD-23-007 利用我们的冠军干预措施，该干预将由四个艾滋病毒护理环境的人员提供 深南。 Champs+干预是通过MHealth平台提供的，以支持PWH至自我管理 他们的艺术方案，并增加了CHW的支持风险，从而增加了现有的冠军干预措施 在非抑制期间减少咨询（性行为和吸毒）以防止艾滋病毒 传播。这项拟议的研究还建立在我们的MCHOICE（U01PS005229）和WISEAPP上 （R01HS025071）研究旨在改善南方深处的艺术依从性和VS。拟议的研究设计 具有以下三倍的目的：1）使目标人群参与文化相关的发展 拟议研究的招聘材料和保留策略，2）评估临床有效性 和干预措施的可持续性，以及3）评估区域化实施 取决于覆盖范围，有效性，采用，实施和维护框架的因素。 最终，这项研究将测试Champs+以促进艺术依从性并抑制PWH的病毒负载 阿拉巴马州，路易斯安那州（奥尔良教区）和密西西比州，美国优先级。重要的是，我们的多 组件干预措施针对多个级别，以解决非 - 抑制 - 一种创新且有影响力的组成部分，可能是公共卫生重要的进口。