Sued Omar, Cecchini Diego, Rolón María José, Calanni Liliana, David Daniel, Lupo Sergio, Cahn Pedro, Cassetti Isabel, Weiss Stephen M, Alcaide Maria Luisa, Rodriguez Violeta J, Mantero Alejandro, Jones Deborah L
Fundación Huésped, Buenos Aires, Argentina.
Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina.
Lancet Reg Health Am. 2022 Sep;13. doi: 10.1016/j.lana.2022.100307. Epub 2022 Jun 23.
Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina.
Regional clinics ( = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient-provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA) and was registered at clinicaltrials.gov, NCT02846350.
Participants were an average age of 39·15 ( = 10·96), 51% were women; intervention participants were older ( = ·019), and more ESOC participants were women (60% vs. 42%, = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence ( = 0·188, = 0·009), HIV viral load ( = -0·095, = 0·027), and self-efficacy ( = 0·063, = 0·001), suggesting the intervention was associated with improved patient-provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy.
These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted.
National Institutes of Health.
脱离艾滋病护理的患者，如错过药物领取、未参加医生问诊，占新增艾滋病感染病例的≥70%。重新参与并维持参与度对于控制艾滋病疫情至关重要。本研究测试了一种由医生提供的循证干预措施，即动机性访谈（MI），以改善阿根廷脱离护理的患者的健康状况、抗逆转录病毒疗法（ART）依从性、艾滋病病毒学抑制、CD+细胞计数、在艾滋病护理中的留存率以及自我效能感。
将地区诊所（n = 6）随机分为MI干预组或强化标准护理（ESOC）组，并招募了n = 360名脱离艾滋病护理的患者。在基线、6个月、12个月、18个月和24个月时评估ART依从性、艾滋病病毒RNA病毒载量、CD+细胞计数留存率和自我效能感。使用医患关系作为中介来检验从分组到主要结局的间接效应。该研究是一项名为阿根廷2的连接与积极选择（COPA）的整群随机临床试验，并在clinicaltrials.gov上注册，注册号为NCT02846350。
参与者的平均年龄为39.15岁（SD = 10.96），51%为女性；干预组参与者年龄较大（p = 0.019），ESOC组女性参与者更多（60%对42%，p = 0.001）。使用混合模型，干预措施对不同分组情况下随时间变化的ART依从性、艾滋病病毒RNA病毒载量、CD+细胞计数留存率或自我效能感没有影响。然而，在分析中介路径时，分组对ART依从性（β = 0.188，p = 0.009）、艾滋病病毒载量（β = -0.095，p = 0.027）和自我效能感（β = 0.063，p = 0.001）存在间接效应，表明该干预措施与改善医患关系相关，而这又与提高ART依从性、降低艾滋病病毒载量和增强自我效能感相关。
这些发现表明，由医生提供的MI可能会增强医患关系、自我效能感和ART依从性，并降低脱离艾滋病护理的患者的艾滋病病毒载量。然而，由于随机分组的整群数量较少，这些发现是初步的，需要进行重复验证。
美国国立卫生研究院。
