RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
Int J Behav Med. 2024 Oct;31(5):787-798. doi: 10.1007/s12529-023-10233-7. Epub 2023 Nov 13.
Low-cost, scalable strategies are necessary to reach the UNAIDS 2030 target of ending HIV as a public health threat. Use of treatment partners, informal caregivers selected by people living with HIV to support antiretroviral therapy adherence, is one such strategy that is included in many countries' HIV guidelines, including Botswana, a country with high HIV prevalence.
From June 2021 to June 2022, we pilot tested a clinic-based treatment partner intervention ("Mopati"), including standardized language for providers to guide patients on treatment partner selection and workshops to train treatment partners on providing non-directive support to patients using a non-confrontational, non-judgmental approach. Sixty unsuppressed patients (30 per clinic) and 45 treatment partners (17 intervention, 28 control) were recruited from an intervention-control clinic matched-pair in Gaborone, Botswana.
Mopati had medium-to-large effects on increasing patients' adherence, adherence self-efficacy, intrinsic adherence motivation, and perceived non-directive support from treatment partners, and decreasing treatment partner caregiver burden. Aggregate viral suppression rates significantly increased in the intervention (vs. control) clinic. Qualitative data from 14 clinic staff, 21 patients, and 16 treatment partners indicated that Mopati was viewed as effective. Providers said the guidance empowered them to be proactive in communicating about adherence; most reported using the guidance.
This study shows preliminary support for the use of treatment partners in HIV care, and further evidence for interventions that leverage patients' existing support. This research can inform ways to improve adherence to HIV treatment as well as the treatment of HIV-related comorbid conditions in lower-resource settings.
ClinicalTrials.gov Identifier: NCT04796610.
为了实现联合国艾滋病规划署 2030 年终结艾滋病作为公共卫生威胁的目标，有必要采取低成本、可扩展的策略。利用治疗伙伴（由艾滋病毒感染者选择的非正式照顾者）来支持抗逆转录病毒治疗的依从性就是这样一种策略，它被包括博茨瓦纳在内的许多国家的艾滋病指南所采纳，博茨瓦纳是一个艾滋病发病率很高的国家。
从 2021 年 6 月到 2022 年 6 月，我们在一个诊所试点测试了一种基于诊所的治疗伙伴干预措施（“Mopati”），包括为提供者提供标准化的语言，以指导患者选择治疗伙伴，以及为治疗伙伴举办研讨会，培训他们使用非对抗性、非评判性的方法为患者提供非直接的支持。从博茨瓦纳哈博罗内的一个干预对照诊所招募了 60 名未被抑制的患者（每个诊所 30 名）和 45 名治疗伙伴（17 名干预，28 名对照）。
Mopati 对增加患者的依从性、依从自我效能、内在依从动机和治疗伙伴的非直接支持感知以及减少治疗伙伴的照顾者负担有中到大的影响。干预诊所的总体病毒抑制率显著增加。来自 14 名诊所工作人员、21 名患者和 16 名治疗伙伴的定性数据表明，Mopati 被认为是有效的。提供者表示，该指导使他们能够主动沟通关于依从性的问题；大多数人报告使用了该指导。
这项研究初步支持在艾滋病毒护理中使用治疗伙伴，并进一步证明了利用患者现有支持的干预措施是有效的。这项研究可以为提高在资源较少的环境中治疗艾滋病毒的依从性以及治疗与艾滋病毒相关的合并症提供信息。
ClinicalTrials.gov 标识符：NCT04796610。
