School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, USA.
Magic City Research Institute, Birmingham AIDS Outreach, Birmingham, AL, USA.
BMC Public Health. 2023 May 24;23(1):942. doi: 10.1186/s12889-023-15616-9.
BACKGROUND: Persons with HIV (PWH) can now achieve a near-normal life expectancy due to antiretroviral therapy (ART). Despite widespread availability of ART in the United States (US), many of the country's approximate 1.1 million PWH are not achieving viral suppression due to poor ART adherence. Viral suppression rates are particularly low in Alabama (AL, 62%) and New York City (NYC, 67%). There is mixed evidence on the efficacy of community health workers (CHW) and mHealth interventions for improving ART adherence and viral suppression in PWH thus, we sought to combine these interventions and test the efficacy for improving health outcomes in PWH. METHODS: The CHAMPS study is a two-arm randomized controlled trial among 300 PWH with suboptimal primary care appointment adherence (n = 150 in AL and 150 in NYC) over the course of 12 months. Participants are randomly assigned to CHAMPS (intervention) or a standard-of-care (control) arm. Participants in the intervention arm are given a CleverCap pill bottle that syncs to the WiseApp to track medication adherence, reminds users to take their medication at a set time, and enables communication with CHW. All participants complete baseline, 6-month, and 12-month follow-up visits where surveys are administered and, CD4 and HIV-1 viral load are obtained through blood draw. DISCUSSION: Maintaining ART adherence has significant implications in HIV management and transmission. mHealth technologies have been shown to optimize the provision of health services, produce positive changes in health behavior, and significantly improve health outcomes. CHW interventions also provide personal support to PWH. The combination of these strategies may provide the necessary intensity to increase ART adherence and clinic attendance among PWH at highest risk for low engagement. Delivering care remotely enables CHW to contact, assess, and support numerous participants throughout the day, reducing burden on CHW and potentially improving intervention durability for PWH. The adoption of the WiseApp coupled with community health worker sessions in the CHAMPS study has the potential to improve HIV health outcomes, and will add to the growing knowledge of mHealth and CHW efforts to improve PWH medication adherence and viral suppression. TRIAL REGISTRATION: This trial was registered with Clinicaltrials.gov (NCT04562649) on 9/24/20.
背景:由于抗逆转录病毒疗法(ART)的应用,艾滋病毒感染者(PWH)现在可以达到接近正常的预期寿命。尽管在美国(美国)广泛提供了 ART,但由于抗逆转录病毒治疗依从性差,该国约 110 万 PWH 中的许多人并未实现病毒抑制。阿拉巴马州(AL,62%)和纽约市(NYC,67%)的病毒抑制率特别低。社区卫生工作者(CHW)和移动健康(mHealth)干预措施在改善 PWH 的抗逆转录病毒治疗依从性和病毒抑制方面的疗效证据不一,因此,我们试图结合这些干预措施,并测试其改善 PWH 健康结果的效果。
方法:CHAMPS 研究是一项为期 12 个月的针对 300 名初级保健预约依从性欠佳的 PWH(AL 中 150 名,NYC 中 150 名)的双臂随机对照试验。参与者被随机分配到 CHAMPS(干预)或标准护理(对照)臂。干预组的参与者获得了一个 CleverCap 药丸瓶,该药丸瓶与 WiseApp 同步,以跟踪药物依从性,提醒用户在设定的时间服药,并使他们能够与 CHW 进行沟通。所有参与者都在基线、6 个月和 12 个月的随访时完成调查,并通过血液采集获得 CD4 和 HIV-1 病毒载量。
讨论:保持抗逆转录病毒治疗的依从性对 HIV 管理和传播具有重要意义。移动健康技术已被证明可以优化卫生服务的提供,改变健康行为,并显著改善健康结果。CHW 干预措施还为 PWH 提供了个人支持。这些策略的结合可能为提高高危低参与度的 PWH 的抗逆转录病毒治疗依从性和就诊率提供必要的强度。远程提供护理使 CHW 能够在一天中的任何时间联系、评估和支持众多参与者,从而减轻 CHW 的负担,并可能提高 PWH 的干预持久性。在 CHAMPS 研究中采用 WiseApp 并结合社区卫生工作者会议有可能改善艾滋病毒健康结果,并将为移动健康和 CHW 努力改善 PWH 药物依从性和病毒抑制的日益增长的知识做出贡献。
试验注册:该试验于 2020 年 9 月 24 日在 Clinicaltrials.gov(NCT04562649)注册。
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