An Audio Music Self-management Program to Improve ART Adherence in Rural GA

旨在提高 GA 农村地区 ART 依从性的音频音乐自我管理计划

• 批准号: 8327458
• 负责人: MARCIA McDonnell Holstad
• 金额: $ 65.7万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8327458
• 关键词: AIDS diagnosis; AIDS prevention; AIDS/HIV problem; Address; Adherence; Adverse effects; Behavior; CD4 Lymphocyte Count; Car Phone; Caring; Chronic; Chronic Disease; Clinic; Clinical; Complex; Confidentiality; County; Data; Disabled Persons; Disease Management; Dose; Drug Monitoring; Drug resistance; Education; Expectancy; Fright; Funding; Goals; HIV; HIV Infections; Hair; Health; Health Services Accessibility; Human Resources; Intervention; Knowledge; Learning; Life; Light; Logistics; Manuals; Measures; Mediator of activation protein; Medical Records; Mental Depression; Modeling; Motivation; Music; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Plasma; Play; Program Effectiveness; Provider; Published Comment; RNA; Radio; Randomized; Randomized Controlled Trials; Regimen; Reporting; Resources; Role; Rural; Rural Community; Rural Population; Sample Size; Sampling; Self Administration; Self Efficacy; Self Management; Self-Administered; Services; Stigmata; Symptoms; Technology; Telephone; Testing; Text; Therapeutic; Time; Time Study; Training; Transportation; Treatment outcome; Viral Load result; Visit; Vulnerable Populations; Work; antiretroviral therapy; arm; cost; design; efficacy testing; experience; follow-up; handicapping condition; health literacy; improved; medication compliance; pill; programs; psychologic; response; rural area; skills; social stigma; sound; standard care; standard of care; success; symptom management; therapy adherence; trend

DESCRIPTION (provided by applicant): This application proposes to revise and evaluate the efficacy of The LIVE Network (LN), an easy to administer, educationally sound portable music-enhanced audio self-management adherence program, for improving ART adherence in HIV+ persons in rural Georgia, a state that ranks 6th in the proportion of AIDS diagnoses per 100,000 in the US and 2nd in the number of rural dwelling HIV infected persons. The LN program was pilot tested in 77 HIV+ persons at an urban clinic (R21 NR010862) over a 12-week period (¿ set at 0.1 due to small sample size). Compared to standard care, those in the LN-arm had significantly improved self-efficacy (p=0.08), higher proportion of undetectable viral loads at all time points (p=.067), and while not statistically significant the LN-arm had higher mean pill counts at 12 weeks (77.8% vs. 70.6%), and higher therapeutic range plasma ART trough levels (80.5% vs. 72%). Participants were overwhelmingly positive about the program. For this project, the LN and accompanying manual will be developed into an interactive mobile application (app), loaded onto smart phones, and introduced to participants at the initial study visit. New songs will be added to the app during follow up visits and brief (30 sec.) motivational and educational song jingles will be sent regularly via text messaging. Smart phones will be used for study activities including pill counts via an app. The program's effectiveness will be tested over 4-years in 240 HIV+ persons starting or changing ART at 5 HIV service agencies in different rural counties in GA. Participants will be randomized (1:1) to LN or to an educational music program app (EP). Assessments will be conducted at baseline and 3, 6, 9 months follow-up. Hair samples for therapeutic drug monitoring will be collected at the study time points as an adherence measure. The program is in a pre-recorded radio talk show format where a disc jockey takes questions and comments from callers about HIV medications and related issues, poses them to experts, and plays songs that shed light on issues that impede adherence self-management. It is self-administered and designed to enhance patients' knowledge, motivation, and self-efficacy in ART adherence self-management. It is built on the known capacity of music to enhance listening appeal, motivation, learning, and recall of information. If successful, the impact on HIV care will be immense and could transform the delivery of HIV adherence self-management education by overcoming barriers of isolation, transportation, confidentiality and stigma in this vulnerable group. Guided by the Information-Motivation-Behavior Model, there are three aims: 1) Revise and adapt the LN program and manual into a mobile app appropriate for rural HIV+ persons. 2) Evaluate the efficacy of the program, compared to the control condition, on the outcomes of adherence (pill counts, drug levels in hair samples, self report), viral load, CD4 counts, drug resistance. 3) Explore: a) the effects of LN on symptoms and symptom management; b) the roles of self-efficacy, outcome expectancies, and personal goal setting as mediators, and depression and health literacy as moderators of adherence. PUBLIC HEALTH RELEVANCE: An Audio Music Self-Management Program to Improve ART Adherence in Rural GA Project Narrative The overall goal of this project is to use technology to improve adherence to antiretroviral therapy (ART) and increase access to ART adherence care for those HIV+ persons living in rural areas. The LIVE Network audio music program mobile application (app) is innovative, practical, portable, and could be rapidly scaled up to address the adherence self-management needs of rural groups nationwide. If successful, the impact on HIV care will be immense and could transform the delivery of HIV self-management and adherence education by overcoming barriers of geographic isolation, transportation, stigma and confidentiality in this vulnerable group.

描述（由申请人提供）：本申请提议修改和评估 LIVE Network (LN) 的功效，LIVE Network 是一种易于管理、具有教育意义的便携式音乐增强音频自我管理依从性计划，用于提高艾滋病病毒感染者的 ART 依从性佐治亚州农村地区的艾滋病诊断比例在美国每 10 万人中排名第六，农村居民艾滋病毒感染者人数排名第二。 12 周期间，城市诊所 (R21 NR010862) 的 77 名 HIV+ 患者（由于样本量较小，设置为 0.1）与标准护理相比，LN 组的患者自我效能显着提高（p=0.08）。 ），根本无法检测到的病毒载量比例更高 时间点 (p=0.067)，虽然不是极其显着，但 LN 组在 12 周时的平均药片数较高（77.8% 对 70.6%），并且治疗范围血浆 ART 谷水平较高（80.5% 对 72%） ），参与者对该项目非常积极，LN 和随附的手册将被开发成交互式移动应用程序 (app)，加载到智能手机上，并在初始研究中向参与者介绍。新歌将来访。 在后续访问期间将其添加到应用程序中，并且将通过短信定期发送简短（30 秒）的励志和教育歌曲歌曲，用于研究活动，包括通过应用程序进行药丸计数。为期 4 年多的 240 名艾滋病毒感染者在佐治亚州不同农村县的 5 个艾滋病毒服务机构开始或改变 ART，参与者将被随机 (1:1) 分配到 LN 或教育音乐计划应用程序 (EP)。在基线和 3、6、9 个月的随访中，将在研究时间点收集用于治疗药物监测的头发样本，作为依从性的衡量标准。它是自我管理的，旨在提高患者的知识、积极性和自我管理能力。 ART 疗效它建立在已知的音乐增强聆听吸引力、动机、学习和信息记忆能力的基础上。如果成功，将对艾滋病毒护理产生影响。 是巨大的，可以通过克服这一弱势群体的隔离、交通、保密和耻辱等障碍，改变艾滋病毒依从性自我管理教育的实施方式。在信息-动机-行为模型的指导下，有三个目标：1) 修改和调整。将 LN 计划和手册纳入适合农村 HIV+ 人群的移动应用程序中 2) 与对照条件相比，评估该计划对依从性结果（药丸数量、头发样本中的药物水平、自我报告）、病毒的有效性。加载， CD4 计数、耐药性 3) 探索：a) LN 对症状和症状管理的影响；b) 自我效能、结果预期和个人目标设定作为调节因素的作用，以及抑郁症和健康素养作为依从性调节因素的作用。 。 公共卫生相关性：旨在提高农村 GA 项目中 ART 依从性的音频音乐自我管理计划 该项目的总体目标是利用技术来提高抗逆转录病毒治疗 (ART) 的依从性，并增加 HIV + 患者获得 ART 依从性护理的机会LIVE Network 音频音乐节目移动应用程序 (app) 创新、实用、便携，并且可以快速扩展以满足农村地区的需求。 如果成功，对艾滋病毒护理的影响将是巨大的，并可能通过克服这一弱势群体的地理隔离、交通、耻辱和保密障碍，改变艾滋病毒自我管理和依从性教育的实施。