Integrating ENGagement and Adherence Goals upon Entry_iENGAGE to Control HIV
| Project Dates: |
2012-07-01 - 2017-06-30 |
| Region: |
United States |
| Research Area: |
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| Funding Agency: |
University of Alabama
NIH (ALL)
|
| PI: |
Amico, K. Rivet
|
| Status: |
Active |
|
Project Summary:
The first year of outpatient HIV medical care is a dynamic, formative and vulnerable time. While adjusting to a life changing diagnosis, patients must simultaneously develop adherence to care and antiretroviral therapy (ART) adherence behavioral skills in order to achieve plasma HIV viral load (VL) suppression. Moreover, maintaining “HIV adherence” in a broader context, including adherence to both care and ART, is essential to sustaining VL suppression over time. Achieving rapid and sustained VL suppression following HIV care initiation has vital consequences to individual health and dramatic implications for secondary HIV prevention. It is alarming that no existing evidence-based intervention supports the development of patient adherence to care and ART skills to promote VL suppression at this vulnerable time. Accordingly, we will draw content from our existing, pilot-tested interventions that target these separate adherence behaviors to evaluate an integrated intervention approach tailored to the needs of an individual initiating outpatient HIV care.
The proposed iENGAGE intervention (integrating ENGagement and Adherence Goals upon Entry) has two overarching goals: (1) to facilitate patient adjustment to a new diagnosis of HIV infection, and, (2) to develop the necessary patient motivation and skills for optimal adherence to HIV care and ART. The following specific aims are driven by a unified conceptual model, linked with explicit measurement instruments, and a detailed analysis plan. Aim 1: Integrate content from our existing, pilot-tested and evidence-based CDC Retention in Care and PACT ART adherence interventions for the iENGAGE intervention to promote rapid and sustained VL suppression among patients newly initiating outpatient HIV care. Aim 2: Evaluate the efficacy of the iENGAGE intervention vs. standard of care in achieving cross-sectional and longitudinal VL suppression. Aim 3: Evaluate mediators of iENGAGE efficacy using dynamic marginal structural models, and also evaluate moderators of intervention effects. The expansive infrastructure afforded by the nationally distributed CFAR Network of Integrated Clinical Systems (CNICS) provides an ideal platform to conduct these aims. Our investigative team has a strong track record of collaboration and the collective expertise in HIV behavioral, clinical and epidemiological sciences to successfully complete this innovative scope of work.
While considerable emphasis and resources have appropriately focused on expanding HIV testing, and interventions have proven efficacious in linking patients from the community to an HIV clinic, a paucity of research has focused on the period immediately following entry into HIV care. The iENGAGE intervention aims to convert this vulnerable time to a transformative period during which patients develop knowledge, motivation and HIV adherence skills to achieve and sustain VL suppression. Study findings will play a pivotal role in addressing the scientific void around this dynamic and formative period – a critical time if we are to maximally realize the potential individual and population health benefits (ie, treatment as prevention) of VL suppression.