Smith Laramie R, Amico K Rivet, Fisher Jeffrey D, Cunningham Chinazo O
a Division of Global Public Health, Department of Medicine , University of California, San Diego School of Medicine , La Jolla , CA , USA.
b Department of Health Behavior and Health Education , School of Public Health, University of Michigan , Ann Harbor , MI , USA.
AIDS Care. 2018 Feb;30(2):255-265. doi: 10.1080/09540121.2017.1344184. Epub 2017 Jun 28.
Sustained retention in HIV medical care is a key health behavior for the long-term health of people living with HIV (PLWH). Approximately 60% of PLWH in the U.S. are poorly retained in HIV care, yet to date, the few available evidence-based retention-promoting interventions are resource and time intensive to implement. The current study describes the feasibility and acceptability of a theory-based retention-promoting intervention designed to meet the needs of a busy clinical care setting. 60 Minutes for Health reflects a low-resource single-session intervention, implemented by a health educator, to PLWH who have had a recent gap in care (≥6-months) in the past 18-months. Intervention content was informed by a situated application of the Information Motivation Behavioral Skills Model and delivered using a Motivational Interviewing-based format. The intervention uses a workbook to guide a series of activities that: (1) Identify and reduce misinformation guiding HIV care attendance. (2) Enhance motivation to maintain care via personal health goals. (3) Build skills for coping with emotional distress related to living with HIV. (4) Increase self-efficacy for navigating the logistics of maintaining care amidst competing priorities. A small feasibility pilot of this intervention protocol was conducted to assess its potential to improve retention in care and to obtain estimates for a larger-scale efficacy trial. Participants were randomized to the 60-minute intervention session (n = 8), or a theory-based time-and-attention control session focused on diet and nutrition (n = 8). Medical records were abstracted to evaluate changes in participants' retention in care status at 12- and 24-months post-intervention. Findings suggest the intervention is both feasible and acceptable to implement with poorly retained PLWH in a clinic setting. Post-intervention a larger proportion of intervention participants were retained in care (12-months: 87.5%, 24-months: 62.5%), compared control participants (12-months: 50.0%, 24-months: 25.0%). Future work should aim to evaluate a larger-scale efficacy trial.
持续接受艾滋病医疗护理是艾滋病毒感染者（PLWH）长期健康的关键健康行为。在美国，约60%的艾滋病毒感染者在接受艾滋病护理方面情况不佳，但迄今为止，为数不多的循证促进留存干预措施实施起来资源消耗大且耗时。本研究描述了一种基于理论的促进留存干预措施的可行性和可接受性，该干预措施旨在满足繁忙临床护理环境的需求。“60分钟健康干预”是一种资源消耗低的单节次干预措施，由一名健康教育工作者对在过去18个月内最近有护理中断（≥6个月）的艾滋病毒感染者实施。干预内容依据信息动机行为技能模型的情境应用制定，并采用基于动机性访谈的形式进行交付。该干预使用一本工作手册来指导一系列活动，这些活动包括：（1）识别并减少影响艾滋病护理就诊的错误信息。（2）通过个人健康目标增强维持护理的动机。（3）培养应对与感染艾滋病毒相关情绪困扰的技能。（4）在有诸多优先事项的情况下，提高处理维持护理相关事宜的自我效能感。针对该干预方案进行了一项小型可行性试点研究，以评估其改善护理留存率的潜力，并为大规模疗效试验获取相关估计数据。参与者被随机分为60分钟干预组（n = 8）或基于理论的关注饮食和营养的时间与注意力对照组（n = 8）。提取医疗记录以评估干预后12个月和24个月时参与者护理留存状况的变化。研究结果表明，该干预在诊所环境中对护理留存率低的艾滋病毒感染者实施既可行又可接受。干预后，与对照组参与者（12个月：50.0%，24个月：25.0%）相比，干预组有更大比例的参与者保持了护理（12个月：87.5%，24个月：62.5%）。未来的工作应致力于评估大规模疗效试验。
