Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT.
Department of Pediatrics, Center for AIDS Research, Emory University School of Medicine, Atlanta, GA.
J Acquir Immune Defic Syndr. 2018 May 1;78(1):34-42. doi: 10.1097/QAI.0000000000001637.
We conducted a randomized clinical trial to test a mobile health behavioral intervention designed to enhance HIV treatment as prevention (B-TasP) by simultaneously increasing combination antiretroviral therapies (cART) adherence and improving the sexual health of people living with HIV.
A cohort of sexually active men (n = 383) and women (n = 117) living with HIV were enrolled. Participants were baseline assessed and randomized to either (1) B-TasP adherence and sexual health intervention or (2) general health control intervention. Outcome measures included HIV RNA viral load, cART adherence monitored by unannounced pill counts, indicators of genital tract inflammation, and sexual behaviors assessed over 12 months.
Eighty-six percent of the cohort was retained for 12-month follow-up. The B-TasP intervention demonstrated significantly lower HIV RNA, OR = 0.56, P = 0.01, greater cART adherence, Wald χ = 33.9, P = 0.01, and fewer indicators of genital tract inflammation, Wald χ = 9.36, P = 0.05, over the follow-up period. Changes in sexual behavior varied, with the B-TasP intervention showing lower rates of substance use in sexual contexts, but higher rates of condomless sex with non-HIV positive partners occurred in the context of significantly greater beliefs that cART reduces HIV transmission.
Theory-based mobile health behavioral interventions can simultaneously improve cART adherence and sexual health in people living with HIV. Programs aimed to eliminate HIV transmission by reducing HIV infectiousness should be bundled with behavioral interventions to maximize their impact and increase their chances of success.
我们进行了一项随机临床试验，以测试一种旨在通过同时提高联合抗逆转录病毒疗法（cART）的依从性和改善艾滋病毒感染者的性健康来增强艾滋病毒治疗即预防（B-TasP）的移动健康行为干预。
招募了一组活跃的男性（n=383）和女性（n=117）艾滋病毒感染者。对参与者进行基线评估，并随机分配到（1）B-TasP 依从性和性健康干预组或（2）一般健康对照组。主要终点包括 HIV RNA 病毒载量、通过未经宣布的药丸计数监测的 cART 依从性、生殖道炎症指标和在 12 个月内评估的性行为。
队列中有 86%的患者保留了 12 个月的随访。B-TasP 干预组的 HIV RNA 显著降低，OR=0.56，P=0.01，cART 依从性显著增加，Wald χ=33.9，P=0.01，生殖道炎症指标显著减少，Wald χ=9.36，P=0.05。在随访期间。性行为的变化有所不同，B-TasP 干预组在性行为中使用物质的比例较低，但在更相信 cART 降低 HIV 传播的情况下，与非 HIV 阳性伴侣发生无保护性行为的比例较高。
基于理论的移动健康行为干预可以同时改善艾滋病毒感染者的 cART 依从性和性健康。旨在通过降低 HIV 传染性来消除 HIV 传播的项目应与行为干预措施相结合，以最大限度地发挥其影响并增加成功的机会。
