Testing the Efficacy of Two Interventions to Improve Health Outcomes and Quality of Life among Rural Older Adults Living with HIV

测试两种干预措施对改善农村艾滋病毒感染者健康状况和生活质量的效果

• 批准号: 10619130
• 负责人: ANDREW E PETROLL
• 金额: $ 64.81万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-28 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619130
• 关键词: Acceleration; Adherence; Advertisements; Age; Aging; Baseline Surveys; Blood; Caring; Case Management; Collection; Communities; Complex; Dependence; Diagnosis; Discrimination; Dryness; Elderly; Enrollment; Epidemic; Evidence based intervention; Face; Food Access; Gender; Goals; HIV; HIV diagnosis; Health; Healthcare Systems; Housing; Individual; Insurance; Intervention; Manuals; Mediating; Mediator; Medical; Morbidity - disease rate; Motivation; Newly Diagnosed; Outcome; Participant; Personal Satisfaction; Persons; Pharmaceutical Preparations; Population; Provider; Quality of life; Race; Randomized; Reporting; Research; Resources; Rural; Rural Population; Sampling; Self Efficacy; Services; Social isolation; Social support; Spottings; Support Groups; Surveys; Technology; Telephone; Testing; Transportation; Viral; Viral Load result; Work; acceptability and feasibility; antiretroviral therapy; barrier to care; cognitive ability; comorbidity; depressive symptoms; design; eHealth; efficacy evaluation; efficacy testing; efficacy trial; epidemic preparedness; follow-up; health disparity; health equity; health related quality of life; improved; informal caregiver; intervention cost; intervention delivery; intervention effect; medication compliance; mortality; peer; primary outcome; recruit; remote assessment; remote delivery; remote intervention; rural area; rural counties; rural dwellers; rural environment; rural residence; rural setting; scale up; secondary outcome; service utilization; social; social interventions; social stigma; success; therapy adherence; tool; transmission process

More than 55,000 people living with HIV (PLH) in the US live in rural areas, and more than 2,300 rural residents are diagnosed with HIV each year. PLH who live in rural areas have higher mortality rates compared with non-rural PLH. Rural PLH are diagnosed with HIV at a more advanced stage than non-rural individuals and present for medical care later, making them more likely to face comorbidities and need complex medical care. Rural PLH are also less likely than their urban counterparts to remain engaged in HIV care and to be virally suppressed. Compared with younger PLH, older PLH may face additional challenges to maintaining their health and wellbeing, and older PLH who also live in rural areas face the doubly challenging prospect of maintaining adherence to HIV care and managing medical conditions while living in a rural environment. Few interventions aimed at increasing viral suppression and improving health-related quality of life (HRQOL) exist for rural older PLH. Our previous qualitative and survey research with rural older PLH nationwide (N = 476) identified low social support, HIV-related stigma, self-efficacy, and structural barriers (such as difficulties with housing, food access, transportation, and insurance) as key predictors of engagement in HIV care, viral suppression, and HRQOL for this population. Based on this, we previously piloted two remotely-delivered interventions for rural older PLH: supportive-expressive peer social support groups and strengths-based case management. The pilot with older PLH in the rural Southern U.S. found the interventions to be feasible, acceptable, and to show evidence of preliminary impact. Based on this work, we propose a full-scale trial to evaluate the efficacy of these two interventions. We will recruit 352 rural older PLH in the Southern U.S.— including in the states prioritized in the US HHS’ “Ending the HIV Epidemic” (EtHE) plan—through partnerships with community agencies and online advertisements. Following baseline surveys (completed online, by mail, or by phone) and HIV viral load testing (via self-collected dried blood spot samples), participants will be randomized to receive or not receive each intervention in a 2x2 factorial design. Follow-up surveys will occur at 4, 8, and 12 months, and viral load testing at 4 and 12 months. Surveys will assess medication adherence, depressive symptoms, HRQOL, covariates, and potential mediators (e.g., social support, HIV stigma, self- efficacy, structural barriers). Primary outcomes are viral suppression, antiretroviral therapy adherence, depressive symptoms and HRQOL, and secondary outcomes are potential mediating mechanisms. We hypothesize that both interventions will increase the proportion of participants that have viral suppression, levels of antiretroviral therapy adherence, and HRQOL and decrease depressive symptoms. Exploratory analyses will evaluate mediators and moderators of intervention effects. We will also assess the acceptability, feasibility, and costs of intervention delivery. Results from this study will provide us with tools to improve health outcomes for rural older PLH and to advance the EtHE plan to eliminate HIV transmission in the U.S.

美国有超过 55,000 名艾滋病毒感染者 (PLH) 生活在农村地区，其中超过 2,300 名农村地区 与农村地区的居民相比，每年被诊断出感染艾滋病毒的艾滋病毒感染者的死亡率更高。 非农村艾滋病病毒感染者 农村艾滋病病毒感染者的诊断阶段比非农村人口更晚。 并稍后就医，使他们更有可能面临合并症并需要复杂的医疗 与城市患者相比，农村艾滋病患者继续参与艾滋病毒护理和接受护理的可能性也较小。 与年轻的 PLH 相比，老年 PLH 可能面临更多的挑战来维持其病毒水平。 健康和福祉，以及居住在农村地区的老年 PLH 面临着双重挑战的前景 在农村环境中生活时坚持艾滋病毒护理并管理医疗状况的情况很少见。 存在旨在加强病毒抑制和改善健康相关生活质量 (HRQOL) 的运动 我们之前对全国农村老年 PLH 进行的定性和调查研究 (N = 476) 确定了低社会支持、与艾滋病毒相关的耻辱、自我效能和结构性障碍（例如与艾滋病毒相关的困难） 住房、食物获取、交通和保险）作为参与艾滋病毒护理、病毒感染的关键预测因素 在此基础上，我们之前试点了两项远程交付。 对农村老年 PLH 的干预措施：支持性表达的同伴社会支持团体和基于优势的案例 美国南部农村老年 PLH 的试点发现干预措施是可行的， 可接受，并根据这项工作提供初步影响的证据，我们建议进行全面试验。 我们将在美国南部招募 352 名农村老年 PLH 来评估这两种干预措施的效果。 包括美国 HHS“终结艾滋病流行”(EtHE) 计划中优先考虑的州——通过合作伙伴关系 与社区机构和在线广告进行基线调查（在线、通过邮件或其他方式完成）。 通过电话）和 HIV 病毒载量检测（通过自行采集的干血斑样本），参与者将 随机接受或不接受 2x2 析因设计中的每项干预措施将在以下时间进行。 4、8 和 12 个月，以及 4 和 12 个月时的病毒载量测试将评估药物依从性， 抑郁症状、HRQOL、协变量和潜在的中介因素（例如社会支持、艾滋病毒耻辱、自我 主要结局是病毒抑制、抗逆转录病毒治疗依从性、 抑郁症状和 HRQOL 以及次要结果是潜在的中介机制。 认为这两种干预措施都会增加受到病毒抑制的参与者的比例， 抗逆转录病毒治疗依从性和 HRQOL 水平，并减少探索性症状。 分析将评估干预效果的中介因素和调节因素，我们还将评估可接受性， 这项研究的结果将为我们提供改善健康的工具。 农村老年 PLH 的成果，并推进 EtHE 计划以消除美国艾滋病毒传播