Computerized Counseling to Promote Positive Prevention and HIV Health in Kenya

计算机化咨询促进肯尼亚的积极预防和艾滋病毒健康

• 批准号: 7915635
• 负责人: Ann Elizabeth Kurth
• 金额: $ 50.68万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-14 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7915635
• 关键词: AIDS prevention; AIDS/HIV problem; Adherence; Adjusted Life Years; Adult; Africa; Behavioral; Belief; Biological; Caring; Chlamydia trachomatis; Clinic; Clinical; Communication; Communication Tools; Computer software; Computers; Counseling; Country; Data; Diagnosis; Disclosure; Dose; Effectiveness; Electronics; Female; Focus Groups; Gonorrhea; HIV; HIV Infections; HIV Seropositivity; HIV-1; Health; Health Communication; Human Resources; Informatics; International; Intervention; Interview; Kenya; Life; Low income; Measures; Modeling; Monitor; Neisseria gonorrhoeae; Participant; Patient Self-Report; Patients; Performance; Pharmacy facility; Prevention; Provider; Psychometrics; Randomized; Randomized Controlled Trials; Reproductive Health; Research; Research Infrastructure; Risk; Risk Assessment; Risk Behaviors; Rural; Secondary Prevention; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases; Solutions; System; Technology; Testing; Time; Training; Translating; Trichomonas vaginalis; Unsafe Sex; Viral Load result; antiretroviral therapy; computerized; condoms; cost; cost effectiveness; economic evaluation; evidence base; innovation; male; prevent; public health relevance; randomized trial; response; safer sex; skills; standard of care; success; therapy adherence; tool; transmission process; trend; usability

DESCRIPTION (provided by applicant): Helping people living with HIV to remain healthy and reduce transmission to sexual partners ('positive prevention') can be accomplished by behavioral counseling and supporting adherence to infectivity-reducing antiretroviral therapy (ART). Positive prevention and ART adherence approaches that are not staff-dependent are urgently needed in Africa, the region hardest hit by HIV and decimated health workforce. Interactive health communication tools offer one approach. We will adapt a computerized counseling intervention found to be efficacious in reducing HIV-1 viral load and risk behaviors in the US ('CARE+') with the largest HIV provider in Kenya, the Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH). Aim 1: Adapt a theoretically driven computerized counseling intervention for use in Kenya ('CARE+_Kenya'). Conduct in-depth interviews with nd 0 urban and rural AMPATH patients to understand HIV support needs, and two staff focus groups to assess counseling practices and beliefs about computer use. Modify intervention content; translate and record audio into local Kiswahili. Adapt skill-building videos (e.g., on secondary prevention, HIV disclosure, ART adherence, reproductive health). Conduct software usability testing with n=20 patients and n=8 staff. Perform 3-day test-retest reliability assessment to establish psychometric performance of measures. Aim 2: Establish biological and behavioral efficacy of CARE+_Kenya. Longitudinal randomized controlled trial (RCT) in one urban and one rural AMAPATH clinic. Randomly assign HIV-positive adults with any missed ART or unprotected sex in last 6 months, >1 sex partner in last year, or sexually transmitted infection (STI) diagnosis in last 3 years, to intervention (n=125) or risk-assessment control (n=125) for baseline, 3, 6, and 9 month sessions. HIV transmission risk will be measured by self-reported unprotected sex with HIV- negative/unknown partner, and trends in Chlamydia trachomatis, Neisseria gonorrhoeae, and T. vaginalis. ART adherence will be measured by HIV-1 viral load, electronic monitoring, pharmacy refill, self-report, and clinic attendance. Aim 3: Establish cost-effectiveness of CARE+_Kenya. At baseline, follow 100 patients t at eachofthe two clinics to evaluate standard of care counseling, and collect time-pen and fcltdyata to t determine costs ndunmet counselin need. Conduct economic evaluation to compare CARE+_Kenya vs. standard of care. If the RCT shows that the intervention reduces viral load and transmission risk behaviors, we will use a Bernoulli transmission dynamics model to estimate number of secondary HIV infections prevented; then reatea ot-ffctivnssmodltocalculate 2 incremental cost-effectiveness ratios: 1) cost per HIV infection averted, and 2) cost per daily adjusted life year saved. If CARE+_Kenya is efficacious and efficient, we will develop a proposal for a cluster-randomized trial to assess translational effectiveness of CARE+_Kenya throughout the AMPATH system. This is directly responsive to PA-08-107's call for innovative, integrated interventions that leverage ART roll-out infrastructure in international settings to benefit people living with HIV. PUBLIC HEALTH RELEVANCE: We will adapt a computerized counseling intervention found to be efficacious in reducing HIV-1 viral load and secondary HIV transmission risk behaviors in the US ('CARE+') with the largest provider of HIV care in Kenya, the Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH). We will conduct a randomized controlled trial to establish efficacy in this high-HIV burden setting, and transmission dynamics modeling and economic evaluation to determine intervention cost-effectiveness.

描述（由申请人提供）：可以通过行为咨询和支持遵守降低感染性抗逆转录病毒疗法（ART）来帮助患有艾滋病毒健康的人保持健康并减少向性伴侣的传播（“积极预防”）。非洲迫切需要预防和艺术依从性的方法，而非洲则需要该地区，该地区受艾滋病毒的打击最严重，卫生劳动力受到了损害。交互式健康交流工具提供了一种方法。我们将适应一种计算机化的咨询干预措施，发现与肯尼亚最大的HIV提供者（预防HIV/AIDS（AMPATH）的学术模型（AMPATH），美国（“ CARE+”）在美国（“ Care+”）中有效地有效。目标1：适应肯尼亚使用的理论驱动的计算机咨询干预措施（“ Care+_kenya”）。对ND 0 Urban和Rural Ampath患者进行深入的访谈，以了解艾滋病毒的支持需求，以及两个员工焦点小组评估有关计算机使用的咨询实践和信念。修改干预内容；翻译并记录音频到当地的基斯瓦希里。适应技巧建设视频（例如，关于二级预防，艾滋病毒披露，艺术依从性，生殖健康）。对n = 20名患者进行软件可用性测试，n = 8个员工。执行为期3天的重测可靠性评估，以建立措施的心理测量表现。目标2：建立Care+_kenya的生物学和行为效率。在一个城市和一个农村Amapath诊所中的纵向随机对照试验（RCT）。在过去的6个月内随机分配具有任何错过的艺术或无保护性别的艾滋病毒阳性成年人，去年> 1个性别伴侣，或者在过去3年内进行性传播感染（STI）诊断（n = 125）或风险评估控制（n = 125）（n = 125），基线3、6和9个月。艾滋病毒传播风险将通过与艾滋病毒/未知伴侣的自我报告的未受保护的性别以及沙眼衣原体，淋病奈瑟氏菌和T.阴道的趋势来衡量。 ART依从性将通过HIV-1病毒负荷，电子监测，药房补充，自我报告和诊所出勤来衡量。目标3：建立护理+_kenya的成本效益。在基线时，在两个诊所的每家诊所中关注100例患者，以评估护理咨询的标准，并收集Time-Pen和Fcltdyata，以确定Ndunmet咨询的成本。进行经济评估以比较护理+_kenya vs.护理标准。如果RCT表明干预措施减少了病毒载荷和传播风险行为，我们将使用Bernoulli传播动力学模型来估计预防继发HIV感染的数量。然后，reatea ot-ffctivnssmodltocalcalulate 2增量成本效益比：1）避免每次艾滋病毒感染的成本，以及2）每天节省的每日调整后的成本。如果Care+_kenya有效而有效，我们将为整个AMPATH系统中的CARE+_KENYA的转化有效性开发一项提案。这直接响应PA-08-107的呼吁进行创新的，综合的干预措施，该干预措施利用国际环境中的艺术推出基础设施来使艾滋病毒感染者受益。公共卫生相关性：我们将适应一种计算机化咨询干预措施，发现在减少美国的HIV-1病毒载荷和二次HIV传播风险行为（“ Care+'）中，肯尼亚的HIV Care提供者是肯尼亚的最大的艾滋病毒护理提供者，这是肯尼亚的最大艾滋病毒护理提供者，这是预防和治疗HIV/AIDS的学术模型（AMPATH）。我们将进行一项随机对照试验，以在此高HIV负担设置以及传播动态建模和经济评估中确定功效，以确定干预成本效益。