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

咨询、教育和支持的依从性联系 (ACCESS) - II

基本信息

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
项目类别：
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

项目摘要

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.

新人类免疫缺陷病毒（HIV+）感染率最高的是黑人和西班牙裔青少年和年轻人 (AYA)。抗逆转录病毒治疗 (ART) 依从性不佳 (<90%) 该队列中 39% 的人描述了这种情况，并且只有一半受到病毒学抑制（HIV 病毒载量<200 拷贝/毫升），导致性传播的高风险。依从行为是复杂的，由多层次的因素塑造社会生态（SE）背景。但目前还缺乏基于理论的 ART 依从干预措施队列。还需要了解与病毒载量相关的症状群结果或依从表型。 K 获奖者护士科学家 Dunn Navarra 博士建立了以下证据：同行主导、技术支持 (WebEx) 认知行为 ART 依从干预的概念，咨询、教育和支持的依从性连接 (ACCESS) (K23-NR015970)。训练有素的艾滋病毒+ 同伴健康教练提供了为期五次的 ART 依从干预，使用视频会议来治疗难以接触到 HIV 病毒载量不受抑制的黑人和西班牙裔 HIV+AYA。接受 ART 的剂量增加了 32% （95th CI=11.2 至 53.3），12 个月时 HIV 病毒载量减少 0.28 log10 (47.5%)。定性研究结果强调 SE 对 ART 依从性的影响，为有关普遍艾滋病毒的精致/新的 ACCESS 内容提供贷款耻辱、药物滥用/心理困扰以及参与艾滋病毒卫生系统的重要性。 PI 寻求机会扩大这一有前途的艾滋病毒生物行为研究计划，并增强她的能力从新研究者身份到独立研究者身份的职业转变。在拟议的 ART 依从干预中， ACCESS II，我们的目标是：1）评估 ACCESS-II 对自我报告 ART 主要结局的影响依从性和艾滋病毒病毒载量以及自我效能、艾滋病毒知识、艾滋病毒耻辱等次要结果，心理困扰、社会支持和药物滥用； 2) 确定哪些 SE 因素（自我效能感、HIV 知识、艾滋病毒耻辱、心理困扰、社会支持和药物滥用）与 ART 相关依从性和 HIV 病毒载量结果。我们的方法包括使用纵向（12 周和 24 周）、两组，针对年龄 18-29 岁的黑人和西班牙裔 HIV+AYA 的随机对照试验 (N=120)。参加者干预条件将使用视频会议与受过培训的 HIV+ 同伴健康同步连接教练将每周提供八次、每次 60 分钟的认知行为激励课程，以改进 ART 坚持。控制参与者将异步连接到基于网络的 HIV ART 依从性教育条件。我们将使用线性和广义线性混合模型来检验 ACCESS II 关于主要和次要结果。将使用视觉来识别依从性表型图形分析 (VGA) 用于检查和分类 3 天自我报告的 ART 依从性的个人轨迹。总之，ACCESS II 是一种创新方法，可以让黑人和西班牙裔 HIV+AYA 参与急需的工作依从性干预，根据先前的研究结果（K23）和当前证据基础的差距证明是合理的。