Kenya Sonjia, Young BreAnne, Escarfuller Sebastian, Jones-Weiss Deborah, Carrasquillo Olveen, Riccio Ana, Yue Pan
Department of General Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
medRxiv. 2024 Dec 12:2024.12.11.24318859. doi: 10.1101/2024.12.11.24318859.
Miami-Dade is an HIV epicenter where Black populations experience excess AIDS-related deaths due to poor medication adherence, which prevents achieving an undetectable HIV viral load (VL). A promising approach to improving HIV outcomes in Black populations has been the use of community health workers (CHWs). Evidence shows CHWs trained in motivational interviewing (MI) may further improve outcomes, however little data exists about Black CHWs trained in MI who support Black patients with HIV. While CHWs traditionally help address social determinants of health in nonclinical locations, there is less information on CHWs who provide support in clinical settings, which may result in even greater improvements in HIV outcomes. To examine effects of CHWs trained in MI who provide HIV care in both clinic and community settings, a randomized controlled trial (RCT) is being conducted in Miami-Dade's largest public hospital. The Integrated Navigation and Support for Treatment, Adherence, Counseling, and Research intervention is a RCT of 300 Black adults with an unmanaged HIV VL (> 200 copies/mL). CHWs trained in MI are embedded into HIV clinical care teams and participate in hospital rounds with clinicians treating inpatients. Participants randomized into the CHW intervention arm receive 12 months of CHW-led health education and assistance with health care navigation and social services. The primary outcome is change in HIV viral load suppression at 12 months. Secondary outcomes include changes in medication adherence and social determinants of health. Study enrollment began in 2023 and will be completed by 2027. The first results are expected to be submitted for publication in 2025. INSTACARE is one of the first RCTs to examine effects of clinic-based support provided by CHWs trained in MI on Black populations with an unmanaged VL and will provide evidence on the impact of such strategies on medication adherence and social determinants of health.
迈阿密-戴德县是一个艾滋病高发地区，黑人因药物依从性差而经历过多与艾滋病相关的死亡，这阻碍了实现不可检测的艾滋病毒载量（VL）。改善黑人艾滋病毒治疗结果的一种有前景的方法是使用社区卫生工作者（CHW）。有证据表明，接受过动机性访谈（MI）培训的社区卫生工作者可能会进一步改善治疗结果，然而，关于接受过MI培训并为感染艾滋病毒的黑人患者提供支持的黑人社区卫生工作者的数据却很少。虽然社区卫生工作者传统上在非临床场所帮助解决健康的社会决定因素，但关于在临床环境中提供支持的社区卫生工作者的信息较少，这可能会使艾滋病毒治疗结果得到更大改善。为了研究接受过MI培训并在诊所和社区环境中提供艾滋病毒护理的社区卫生工作者的效果，正在迈阿密-戴德县最大的公立医院进行一项随机对照试验（RCT）。“治疗、依从性、咨询和研究的综合导航与支持”干预措施是一项针对300名艾滋病毒载量未得到控制（>200拷贝/毫升）的成年黑人的随机对照试验。接受过MI培训的社区卫生工作者被纳入艾滋病毒临床护理团队，并与治疗住院患者的临床医生一起参加医院查房。随机分配到社区卫生工作者干预组的参与者接受为期12个月的由社区卫生工作者主导的健康教育，并在医疗保健导航和社会服务方面获得帮助。主要结果是12个月时艾滋病毒载量抑制情况的变化。次要结果包括药物依从性和健康的社会决定因素的变化。研究招募工作于2023年开始，将于2027年完成。预计首批结果将于2025年提交发表。INSTACARE是首批研究接受过MI培训的社区卫生工作者在临床环境中为艾滋病毒载量未得到控制的黑人提供支持的效果的随机对照试验之一，并将提供关于此类策略对药物依从性和健康的社会决定因素影响的证据。
