1 Center for Health Equity Research, Brown University, Providence, Rhode Island.
2 Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
AIDS Patient Care STDS. 2019 Jan;33(1):21-24. doi: 10.1089/apc.2018.0138.
Adolescents are disproportionately impacted by HIV in the United States. Optimal effects from antiretroviral therapy (ART) can be achieved through stringent adherence to a daily medication regimen; for adolescents, this may be interrupted due to complex barriers unique to this age group. We previously conducted formative qualitative interviews with HIV-infected adolescents to identify key barriers facing adolescents regarding ART adherence and potential strategies to address these barriers. These data were used to inform an ART adherence intervention designed to overcome difficulties unique to HIV-infected adolescents (e.g., internalized stigma and HIV-related shame, disclosure to sexual partners, social life, and extracurricular activities at school, etc.). The resulting intervention-"Positive Strategies To Enhance Problem-solving Skills (Positive STEPS)"-combines five individual counseling sessions with daily text message reminders. We conducted a pilot randomized controlled trial of the intervention against a standard of care control and report on the feasibility of procedures and participant acceptability of the intervention in terms of content, structure, and format. ART adherence was measured in both arms through Medication Event Monitoring System pill caps and self-report. Feasibility and acceptability of the Positive STEPS intervention was evidenced by 90% retention for the intervention sessions; 100% completion of the four-month assessment; and positive responses on postintervention evaluation forms (all intervention participants rated Positive STEPS as "acceptable" or "very acceptable") and brief exit interviews. At the 4-month assessment visit, the change in ART adherence among the intervention group [mean change score = 13%, standard deviation (SD) = 29.5] was significantly higher compared with the standard of care group (mean change score = -26%, SD = 26.0; Cohen's d effect size = 1.43, confidence interval = 0.17-2.49, p = 0.02). Future testing of the intervention in a fully powered randomized controlled trial to determine efficacy is warranted.
美国青少年受到 HIV 的不成比例影响。通过严格遵守每日药物治疗方案，可以实现抗逆转录病毒疗法 (ART) 的最佳效果；对于青少年来说，由于这个年龄段特有的复杂障碍，这可能会被打断。我们之前对感染 HIV 的青少年进行了形成性定性访谈，以确定青少年在 ART 依从性方面面临的关键障碍，以及解决这些障碍的潜在策略。这些数据被用于为一项旨在克服感染 HIV 的青少年所特有的困难的 ART 依从性干预提供信息（例如，内化的耻辱感和与 HIV 相关的羞耻感、向性伴侣透露、社交生活和课外活动等）。由此产生的干预措施——“增强解决问题技能的积极策略 (Positive STEPS)”——将五次个体咨询与每日短信提醒相结合。我们对该干预措施进行了一项针对标准护理对照的试点随机对照试验，并报告了该程序的可行性以及干预措施在内容、结构和格式方面对参与者的可接受性。通过 Medication Event Monitoring System 药丸帽和自我报告，在两个手臂中都测量了 ART 依从性。Positive STEPS 干预措施的可行性和可接受性表现在干预会议的保留率为 90%；完成了为期四个月的评估；以及对干预后评估表的积极回应（所有干预参与者都将 Positive STEPS 评为“可接受”或“非常可接受”）和简短的退出访谈。在 4 个月的评估访问中，干预组的 ART 依从性变化[平均变化分数=13%，标准差 (SD)=29.5]明显高于对照组（平均变化分数=-26%，SD=26.0；Cohen's d 效应量=1.43，置信区间=0.17-2.49，p=0.02）。需要进一步进行全面的随机对照试验来测试该干预措施的疗效。
