It is clear that the national goal of establishing an AIDS-free generation cannot be achieved until effective, practical strategies for ensuring adherence with antiretroviral treatment (ART) are implemented. The personal and societal benefits of highly effective ART are blunted when patients do not adhere to their treatment regimens, as is too often the case. Despite decades of seminal work developing interventions to increase adherence, much work remains to be done: today less than half of diagnosed and treated HIV-seropositive patients are fully adherent and only about one-fourth (19 to 28%) of all HIV-infected persons in the U.S. have suppressed HIV viral loads. Non-adherence is costly at many levels. It is not just the non-adherent person who pays a price by risking individual health: non-adherence causes drug-resistance, and drug- resistant strains transmitted to others will require much more complex, and expensive, treatment to suppress viral load. Thus, there is an urgent need for researchers to develop novel approaches to increase adherence among the many individuals who struggle with this problem. For more than a century, public health strategies have effectively reduced, and in some cases eliminated, a range of infectious diseases in the U.S. In the case of adherence to HIV treatment, current interventions administered by individual HIV medical care providers/settings are only partially effective. Augmenting such strategies with a community-partnered approach carries great promise for improving treatment outcomes and reducing disease transmission at the population level. The Candidate is a nurse practitioner with a longstanding commitment to patient-oriented research with vulnerable populations of HIV-infected people. By educating the Candidate in public health methods and behavior-change science, this three-year mentored development plan will position her to function as a community-based independent principal investigator in HIV treatment adherence research. The career development plan includes obtaining a certificate in public health while carrying out mentored training and research experiences. The research plan will use community-based participatory research (CBPR) methods to develop a novel community- partnered, peer-led HIV treatment adherence intervention grounded in Social Cognitive Theory.
Sadly, even though treatment for HIV disease can be as simple as taking one pill a day, many people struggle with adherence and are failing treatment. If we are to reach the national goal of an AIDS-free generation and maximize the public health benefits of HIV treatment as prevention, then we must develop population-level interventions that can help people adhere to their HIV medications for a lifetime. This study will address the major problem of non-adherence to HIV treatment in a Midwestern population using a novel community-partnered, peer-led approach.
