Although HIV clinical management has improved dramatically since the advent of highly active antiretroviral therapy (HAART), engaging individuals into HIV care at every stage of illness poses significant challenges. Treatment advocacy (TA) programs have been implemented by AIDS service organizations (ASOs) in part as a response to these challenges.
TA aims to empower patients through client-centered counseling regarding HIV and antiretroviral therapy (ART), advocating on behalf of the patient with providers and the health care system, and making referrals to health care and clinical trials. Although TA programs have been in existence for most of the HIV epidemic and represent a potentially brief and cost-effective intervention that can be effectively implemented across ASOs in the U.S., we are not aware of any systematic, rigorous evaluations of its effects on engagement in care, initiation of ART, and ART adherence. No research has yet determined which elements of TA programs are important for successful HIV care management. We propose to conduct an exploratory investigation of the TA program at AIDS Project Los Angeles (APLA), the largest ASO in Los Angeles. We will combine a process evaluation of the influence of TA on key HIV care management decisions with longitudinal quantitative assessments administered to TA and non-TA clients. The process evaluation will consist of qualitative interviews with 42 clients, treatment advocates, and medical providers. In addition, a diverse sample of 90 clients, 45 who receive TA services from APLA, and a socio- demographically comparable group of 45 clients of a different ASO that does not offer TA services, will be tracked over 6 months. We will monitor initial engagement in HIV care among 30 clients with no HIV primary care provider; initiation of ART among 30 clients with CD4<350; and adherence to medications among 30 clients on ART. We will conduct a preliminary assessment of the effects of TA services on key decisions and outcomes related to HIV care, and explore factors and specific components of the TA program that facilitate or impede TA's effects. In addition to evaluating overall effects, we will explore correlates of successful outcomes among African American and Latino clients in particular. This study has high potential to influence the public health, as its findings may guide the development of interventions to enhance TA services in ASOs across the U.S., as well as policy efforts ultimately aimed at improving the health of people with HIV. ? ? ?
| Bogart, Laura M; Wagner, Glenn J; Mutchler, Matt G et al. (2012) Community HIV treatment advocacy programs may support treatment adherence. AIDS Educ Prev 24:1-14 |
| Mutchler, Matt G; Wagner, Glenn; Cowgill, Burt O et al. (2011) Improving HIV/AIDS care through treatment advocacy: going beyond client education to empowerment by facilitating client-provider relationships. AIDS Care 23:79-90 |
| Mutchler, Matt G; Bogart, Laura M; Elliott, Marc N et al. (2008) Psychosocial correlates of unprotected sex without disclosure of HIV-positivity among African-American, Latino, and White men who have sex with men and women. Arch Sex Behav 37:736-47 |
