Community-based accompaniment with supervised antiretrovirals in Lima, Peru

在秘鲁利马以社区为基础配合监督抗逆转录病毒药物

基本信息

批准号：
8257978
负责人：
SONYA S SHIN
金额：
$ 62.59万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-17 至 2014-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8257978
关键词：
Address Adherence Adoption Affect Anti-Retroviral Agents Behavior Clinical Clinical Trials Communities Complex Control Groups Cost Effectiveness Analysis Country Data Developing Countries Development Directly Observed Therapy Dose Eligibility Determination Enrollment Evaluation Failure HIV Health Heterogeneity Highly Active Antiretroviral Therapy Income Individual Intervention Life Link Mediating Methods Modeling Outcome Outcome Study Participant Patients Peru Play Population Study Poverty Publishing Randomized Controlled Trials Research Research Priority Resources Review Literature Risk Salvage Therapy Social Network Social support Stigmata Subgroup Substance abuse problem Supervision Target Populations Testing Treatment Effectiveness Treatment Efficacy United States Viral Load result Visit Vulnerable Populations Work antiretroviral therapy base cost effective cost effectiveness design experience improved innovation intervention effect member psychosocial public health relevance randomized trial scale up social capital social stigma standard care standard of care stress management therapy design treatment adherence treatment strategy

项目摘要

DESCRIPTION (provided by applicant): We propose a cluster-randomized trial to assess the impact of community-based DOT-HAART on HIV-positive individuals and community members in Lima, Peru. We will enroll individuals living in extreme poverty who are starting either first-line HAART or salvage therapy due to virologic failure. Those residing in intervention clusters will receive 12 months of DOT-HAART. We aim to 1) assess the proportion with suppressed HIV viral load at 18 and 24 months after starting HAART among those receiving community-based DOT-HAART versus the control group; 2) compare social capital among community members in DOT-HAART versus control communities; and 3) assess the cost-effectiveness of community-based DOT-HAART. Innovative aspects of this proposal include 1) a targeted intervention for the most vulnerable subgroup of individuals starting HAART (i.e. those living in extreme poverty); 2) a community- based DOT-HAART intervention designed specifically to achieve long-term efficacy; 3) cost- effectiveness analysis; and 4) assessment of the intervention effect on community-level social capital. These study components will inform how best to design and implement DOT-HAART strategies in Peru and other resource-poor settings. By offering a practical, efficacious and cost-effective model of DOT-HAART for resource-poor settings, the findings of this study could improve global efforts to achieve excellent long-term clinical outcomes among individuals on HAART. PUBLIC HEALTH RELEVANCE: Given the limited resources and magnitude of human immunodeficiency virus (HIV) treatment scale-up in resource-poor countries, cost-effective, efficacious adherence interventions for resource-poor settings are urgently needed. Despite accumulating evidence that directly observed therapy of highly active antiretroviral therapy (DOT- HAART) is effective, how best to apply DOT-HAART in resource-poor settings remains unanswered. Development of DOT-HAART interventions with long-term efficacy, refinement of target populations, and evaluation of cost-effectiveness are all scientific research priorities that are urgently needed to inform efforts to implement DOT-HAART in settings with limited resources.

描述（由申请人提供）：我们提议进行一项整群随机试验，以评估基于社区的 DOT-HAART 对秘鲁利马的 HIV 阳性个体和社区成员的影响。我们将招募生活在极端贫困中、因病毒学失败而开始一线 HAART 或挽救治疗的个人。居住在干预集群中的人将接受 12 个月的 DOT-HAART。我们的目标是 1) 评估接受基于社区的 DOT-HAART 的患者与对照组相比，在开始 HAART 后 18 个月和 24 个月时 HIV 病毒载量受到抑制的比例； 2) 比较 DOT-HAART 社区成员与对照社区成员的社会资本； 3) 评估基于社区的 DOT-HAART 的成本效益。该提案的创新之处包括 1) 对开始 HAART 的最弱势群体（即生活在极端贫困中的人）进行有针对性的干预； 2) 专门为实现长期疗效而设计的基于社区的 DOT-HAART 干预措施； 3）成本效益分析； 4）社区层面社会资本干预效果评估。这些研究内容将告知如何在秘鲁和其他资源匮乏的地区最好地设计和实施 DOT-HAART 策略。通过为资源匮乏的环境提供实用、有效且具有成本效益的 DOT-HAART 模型，本研究的结果可以改善全球努力，使 HAART 个体实现优异的长期临床结果。公共卫生相关性：鉴于资源匮乏国家的资源有限和扩大人类免疫缺陷病毒（HIV）治疗规模，迫切需要对资源匮乏地区采取具有成本效益、有效的依从性干预措施。尽管越来越多的证据表明直接观察的高效抗逆转录病毒疗法 (DOT-HAART) 是有效的，但如何在资源匮乏的环境中最好地应用 DOT-HAART 仍然没有答案。开发具有长期疗效的 DOT-HAART 干预措施、细化目标人群以及评估成本效益都是科学研究的重点，迫切需要为在资源有限的环境中实施 DOT-HAART 的努力提供信息。