Adherence Connection for Counseling, Education, and Support (ACCESS) - II

咨询、教育和支持的依从性联系 (ACCESS) - II

• 批准号: 10414820
• 负责人: Ann-Margaret Dunn-Navarra
• 金额: $ 39.48万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-18 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10414820
• 关键词: Adherence; Adolescent and Young Adult; Affect; Age; Behavior Therapy; Behavioral; Black race; Career Mobility; Chronically Ill; Cognitive; Complex; Counseling; Disclosure; Discrimination; Dose; Education; Goals; HIV; HIV Infections; HIV antiretroviral; HIV-infected adolescents; Health; Health Personnel; Health Services Accessibility; Health system; Hispanic; Individual; Intervention; Knowledge; Methods; Modeling; Motivation; National Institute of Nursing Research; Nurses; Online Systems; Outcome; Participant; Patient Self-Report; Phenotype; Public Health; Randomized Controlled Trials; Reporting; Research; Research Personnel; Scientist; Self Efficacy; Self Management; Sexual Transmission; Social support; Technology; Training; Travel; Videoconferencing; Viral Load result; Virus Diseases; Visual; antiretroviral therapy; base; behavioral adherence; biobehavior; care outcomes; cohort; compliance behavior; cultural competence; efficacy evaluation; efficacy testing; evidence base; high risk; improved; innovation; internalized stigma; lens; medication compliance; minority health disparity; peer; prevent; primary outcome; programs; psychological distress; racial and ethnic; secondary outcome; social stigma; substance use; symptom cluster; treatment adherence

The highest rates of new human immunodeficiency virus infection (HIV+) are among Black and Hispanic adolescents and young adults (AYA). Suboptimal antiretroviral treatment (ART) adherence (<90%) is described among 39% of this cohort, and only half are virologically suppressed (HIV viral load <200 copies/ml), leading to high risk for sexual transmission. Adherence behavior is complex, shaped by a multi-level socioecological (SE) context. Yet there is a paucity of t heory based ART adherence interventions for this cohort. There is also a need to gain understanding of the symptom clusters associated with viral load outcomes or adherence phenotypes. Dr. Dunn Navarra, a K awardee nurse scientist, established proof of concept for a peer-led, technology-enabled (WebEx) cognitive behavioral ART adherence intervention, Adherence Connection for Counseling, Education, and Support (ACCESS) (K23-NR015970). Trained HIV+ peer health coaches delivered a five-session, ART adherence intervention, using videoconferences for hard-to- reach Black and Hispanic HIV+AYA with unsuppressed HIV viral load. ART doses taken increased by 32% (95th CI=11.2 to 53.3) with a 0.28 log10 (47.5%) reduction in HIV viral load at 12 months. Qualitative findings highlighted SE influences on ART adherence lending to refined/new ACCESS content on pervasive HIV stigma, substance use/psychological distress, and the importance of engagement with the HIV health system. The PI seeks the opportunity to expand this promising program of HIV biobehavioral research and enhance her career transition from new to independent investigator status. In the proposed ART adherence intervention, ACCESS II, we aim to: 1) evaluate the effect of ACCESS-II on the primary outcomes of self-reported ART adherence and HIV viral load and secondary outcomes of self-efficacy, HIV knowledge, HIV stigma, psychological distress, social support, and substance use; and 2) identify which SE factors (self-efficacy, HIV knowledge, HIV stigma, psychological distress, social support, and substance use) are associated with ART adherence and HIV viral load outcomes. Our methods include using a longitudinal (12 and 24-weeks), two- group, randomized control trial with Black and Hispanic HIV+AYA, ages 18-29 years (N=120). Participants in the intervention condition will use videoconferencing to connect synchronously with trained HIV+ peer health coaches who will deliver eight weekly, 60-minute cognitive behavioral motivational sessions for improved ART adherence. Participants in the control will connect asynchronously to a web-based HIV ART adherence education condition. We will use linear and generalized linear mixed models to examine the efficacy of ACCESS II on primary and secondary outcomes. Adherence phenotypes will be identified using visual graphical analysis (VGA) to examine and classify individual trajectories of 3-day self-reported ART adherence. In summary, ACCESS II is an innovative approach to engage Black and Hispanic HIV+AYA in a much needed adherence intervention, justified with prior research findings (K23) and current gaps in the evidence-base.

新的人类免疫缺陷病毒感染（HIV+）的最高率是黑人和西班牙裔 青少年和年轻人（AYA）。次级抗逆转录病毒治疗（ART）依从性（<90％）为 在39％的该队列中描述，只有一半在病毒学上被抑制（HIV病毒载荷<200拷贝/ml）， 导致性传播的高风险。 依从性行为是复杂的，由多层次塑造 社会生态（SE）背景。然而t很少 基于母亲的艺术依从性干预措施 队列。还需要了解与病毒负荷相关的症状簇 结果或依从性表型。 K获奖护士科学家Dunn Navarra博士建立了证明 支持同行的，以技术为基础的（WebEx）认知行为艺术依从性干预的概念， 辅导，教育和支持的依从性连接（访问）（K23-NR015970）。训练有素的艾滋病毒+ 同伴健康教练使用视频会议进行了五项课程，即艺术依从性干预措施 与未受抑制的HIV病毒负荷达到黑色和西班牙裔HIV+AYA。服用的艺术剂量增加了32％ （第95 CI = 11.2至53.3）在12个月时减少HIV病毒负荷的0.28 log10（47.5％）。定性发现 强调SE对艺术依从性贷款的影响，用于普遍艾滋病毒的精致/新访问内容 污名，药物使用/心理困扰以及与艾滋病毒卫生系统互动的重要性。 PI寻求机会扩大这一有前途的HIV生物行为研究计划，并增强她 从新的到独立调查员地位的职业过渡。在拟议的艺术依从性干预中， Access II，我们的目标是：1）评估Access-II对自我报告艺术的主要结果的影响 依从性和HIV病毒载荷以及自我效能感，艾滋病毒知识，艾滋病毒污名，次要结果 心理困扰，社会支持和药物使用； 2）确定哪些SE因素（自我效能感，艾滋病毒 知识，艾滋病毒污名，心理困扰，社会支持和吸毒）与艺术有关 依从性和HIV病毒负荷结果。我们的方法包括使用纵向（12个和24周），两种 小组，黑色和西班牙裔HIV+AYA的随机对照试验，年龄在18-29岁之间（n = 120）。参与者 干预条件将使用视频会议与训练有素的艾滋病毒+同伴健康同步联系 教练将每周提供八次，60分钟的认知行为动机会议，以改善艺术 坚持。控件的参与者将异步连接到基于网络的艾滋病毒艺术依从性 教育条件。我们将使用线性和广义的线性混合模型来检查 访问初级和次要结果。将使用视觉识别依从性表型 图形分析（VGA）以检查和分类为3天自我报告的艺术依从性的单个轨迹。 总而言之，Access II是一种互动的创新方法，可以在急需的 依从性干预措施，与先前的研究结果（K23）和循证库中当前差距合理。