Bouris Alida, Voisin Dexter, Pilloton Molly, Flatt Natasha, Eavou Rebecca, Hampton Kischa, Kuhns Lisa M, Eder Milton, Schneider John A
School of Social Service Administration, University of Chicago, Chicago, IL, USA ; STI/HIV Intervention Network, University of Chicago, Chicago, IL, USA.
Department of Medicine, University of Chicago, Chicago, IL, USA.
J AIDS Clin Res. 2013 Aug 31;4. doi: 10.4172/2155-6113.1000236.
Young Black men who have sex with men and transgender persons (YBMSMT) aged 13-29 carry the nation's highest burden of new HIV infections. Studies indicate that YBMSMT have poor retention in care, which is associated with reduced medication adherence and increased virologic failure.
Project nGage is a randomized controlled (RCT) trial evaluating the feasibility and preliminary efficacy of a brief, dyadic intervention designed to promote adherence to HIV primary care in safety-net clinics. Network visualization is used to identify and engage a support confidant (SC) from participants' social networks. A social work interventionist then meets with the SC and SC-participant dyad to activate and maintain HIV-specific social support.
Project nGage is operating in two phases. In Phase I, the Team refined study protocols based on pilot testing. In Phase II, 94 HIV infected YBMSMT ages 16-29 will be recruited, enrolled and randomly assigned to receive Project nGage or treatment as usual (TAU). The primary outcome is appointment attendance; the secondary outcomes are medication adherence and viral load.
Implementation challenges include coordinating sites, managing dyadic intervention logistics, and recruiting non-adherent patients or those who have fallen out of care. The team continues to address implementation issues as the study progresses.
Project nGage is addressing a gap in HIV care-related research by focusing on supportive relationships as a mechanism through which to promote retention in care. Pending study results, a larger RCT would compare the relative effectiveness of the Project nGage intervention versus TAU over 18 to 24 months.
13至29岁与男性发生性行为的年轻黑人及跨性别者（YBMSMT）承担着全国新增艾滋病毒感染的最高负担。研究表明，YBMSMT在医疗护理中的留存率较低，这与药物依从性降低和病毒学失败增加有关。
nGage项目是一项随机对照试验（RCT），评估一种简短的二元干预措施在安全网诊所促进艾滋病毒初级护理依从性的可行性和初步疗效。网络可视化用于从参与者的社交网络中识别并确定一名支持密友（SC）。然后，一名社会工作干预者会与SC及SC-参与者二元组会面，以激活并维持针对艾滋病毒的社会支持。
nGage项目分两个阶段开展。在第一阶段，研究团队根据试点测试完善了研究方案。在第二阶段，将招募、登记94名年龄在16至29岁之间感染艾滋病毒的YBMSMT，并将他们随机分配接受nGage项目或常规治疗（TAU）。主要结局是预约就诊率；次要结局是药物依从性和病毒载量。
实施过程中的挑战包括协调各站点、管理二元干预的后勤工作，以及招募不依从患者或失访患者。随着研究的推进，团队继续解决实施问题。
nGage项目通过将重点放在支持性关系上，将其作为促进医疗护理留存率的一种机制，来填补艾滋病毒护理相关研究的空白。在研究结果出来之前，一项更大规模的随机对照试验将比较nGage项目干预措施与常规治疗在18至24个月内的相对有效性。
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