Making universal, free-of-charge antiretroviral therapy work for sexual and gender minority youth in Brazil

为巴西的性少数群体和性别少数青年提供普遍、免费的抗逆转录病毒治疗

• 批准号: 10612852
• 负责人: Katie Brooks Biello
• 金额: $ 20.2万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10612852
• 关键词: 19 year old; Address; Adherence; Age; Agreement; Anti-Retroviral Agents; Appointment; Attention; Behavioral; Behavioral Model; Bisexual; Brazil; Caring; Charge; Clinic; Cognitive; Communities; Counseling; Cues; Data; Development; Dose; Educational process of instructing; Ensure; Face; Feedback; Focus Groups; Fostering; Funding; Future; Gays; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Healthy Eating; Hour; Incidence; Individual; Intervention; Interview; Measures; Mediator; Medical; Medical Records; Methods; Moods; Morbidity - disease rate; Motivation; National Institute of Mental Health; Outcome; Participant; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Phase; Plasma; Population; Population Intervention; Prevalence; Prevention; Problem Solving; Procedures; Process; Provider; Qualitative Research; Randomized; Randomized, Controlled Trials; Records; Reporting; Research; Risk Reduction; Self Efficacy; Services; Sexual Transmission; Sexual and Gender Minorities; Sexual and Gender Minority Youth; Social support; Standardization; Structure; Technology; Testing; Text Messaging; Theoretical model; Time; Transportation; Travel; Viral; Viral Load result; Work; Youth; aged; animation; antiretroviral therapy; arm; efficacy trial; experience; group counseling; group intervention; improved; improved outcome; informant; intervention delivery; intervention refinement; men; mortality; pilot test; pilot trial; post intervention; pre-exposure prophylaxis; primary outcome; programs; recruit; service organization; side effect; skills; social; social stigma; standard of care; substance use; theories; therapy adherence; therapy development; transgender women; transmission process; treatment adherence; treatment program

Background. Sexual and gender minority (SGM) youth account for the largest number of incident HIV infections in Brazil. Although HIV can be managed with ongoing antiretroviral therapy (ART), exceptionally high levels of adherence are required. Brazil has implemented a comprehensive HIV treatment program with broad access to ART, but this program does not specifically address barriers to optimal ART adherence, particularly for SGM youth who experience many challenges taking their medication as prescribed. Overview. This application seeks to develop and pilot test a theory-based, integrated technology and counseling intervention to improve ART adherence among HIV infected SGM youth (ages 15-24) in Rio de Janeiro, Brazil. The intervention aims to improve social support, self-efficacy for taking ART, and teach skills for problem-solving barriers to promote better adherence. To inform the content, structure, and format of the proposed intervention, the MPIs recently conducted focus groups with SGM youth (N = 18) and key informant interviews (N = 7) with medical providers and staff at local HIV service organizations working closely with SGM youth in Rio de Janeiro. Across focus groups and key informant interviews there was universal agreement that an intervention should capitalize on and enhance social support structures among SGM youth, and address their specific concerns, especially as related to the individual (e.g., ART side effects, mood, substance use), social (e.g., HIV/SGM stigma), and structural (e.g., clinic hours, transportation challenges) barriers that they regularly face. Theoretical Model. The intervention is guided by Social Cognitive and Social Support Theories and is grounded in the social and contextual realities of SGM youth living with HIV in Brazil. Specifically, social support is emphasized and informational, problem-solving and cognitive-behavioral “steps” are addressed over 4-group adherence counseling sessions, which include short video vignettes that seek to normalize adherence challenges. In addition, daily tailored SMS text messages are delivered as part of the intervention to facilitate social-cognitive cues to take medications as prescribed. Research Plan. Phase 1: Refine and enhance participant acceptability of the intervention and resolve any issues with intervention delivery/implementation; this will be achieved by convening and obtaining feedback from our youth community advisory board throughout this phase and subsequent phases; and by conducting an open-phase pilot with up to 12 SGM youth, with post-intervention exit interviews, as well as obtaining feedback from our youth community advisory board throughout this and subsequent phases. Phase 2: Examine, in a pilot randomized controlled trial, the feasibility, acceptability and potential impact of the proposed intervention among 72 SGM youth who will be equally randomized to the intervention or a time- and attention-matched control condition with standard of care. The outcomes are improved ART adherence (Wisepill, pharmacy assessment and self-report), retention in care and viral load suppression. Study assessments will be conducted at baseline, 3- and 6-months.

背景。 巴西的感染。 需要遵守水平。 获得艺术品，但该程序并未专门解决最佳艺术依从性的障碍，尤其是 对于经历了许多挑战的SGM青年，他们的药物是概述 应用程序旨在开发和试点测试基于理论的，集成的技术和咨询国际 为了改善在巴西里约热内卢的艾滋病毒中的艺术依从性（15-24岁） 间隔旨在改善社会支持，自我效能的艺术和教授解决问题的技能 促进更好的依从性的障碍。 MPI最近与SGM青年（n = 18）和关键的Inforc访谈（n = 7）进行了焦点小组 当地艾滋病毒服务组织的医疗提供者和工作人员与里约热内卢的SGM青年紧密合作 Janeiro。 shoud资本化并增强了SGM青年的社会支持结构，并解决其特定 担心，特别是与个人有关（例如，艺术副作用，情绪，使用物质），社会（例如， HIV/SGM污名）和结构性（例如，诊所小时，运输挑战）障碍。 理论模型。干预是由社会认知和社会支持理论指导的，就是IS是IS是IS IS IS IS。 基于巴西艾滋病毒的SGM青年的社会和背景现实。 强调支持，并增加了信息，解决问题和认知行为的“步骤” 4组依从性咨询会议，其中包括旨在使依从性正常化的简短视频小插曲 挑战。此外，每日量身定制的短信是干预的一部分 社会认知提示将药物作为归属研究计划。 干预措施的干预和解决方案的特定性； 这将通过召集和获得我们的青年社会咨询委员会的反馈来实现 在此阶段和随后的阶段； 青年，进行干预后退出访谈，并遵守我们青年社区咨询的反馈 在此阶段和随后的第2阶段。 72名SGM青年对支撑性干预的饮食能力，可接受性和潜在影响 同样将具有标准护理的时间和时间匹配的控制条件随机分配。 结果是改善艺术依从性（Wisepill，药房评估和自我报告），保留 护理和病毒载量支持将在基线上进行