With a population of over 40 million people, Argentina has an estimated 88,000 to 150,000 persons living with HIV (UNAIDS/WHO, 2008~ National AIDS Program), with an estimated prevalence of 0.5% of the adult population (UNAIDS, 2009). Once primarily among high risk groups, the HIV/AIDS epidemic in Argentina is now shifting to the heterosexual population and heterosexual transmission accounts for 48% of HIV in men and 87% in women (Pando et al., 2010), making them the fastest growing transmission group (Cohen et al., 2006). The Government of Argentina has made antiretroviral (ARV) medications available to all who need it and has already distributed ARVs to approximately 70% of the HIV infected population (UNAIDS/WHO, 2008). However, if the benefits of large scale provision of ARV therapy are to be maximized, education and motivation to optimize the level of adherence among HIV positive individuals must be systematically incorporated into HIV care. Given the level of access to antiretroviral therapy (ART) in Argentina, optimizing ART adherence could significantly impact both those infected and uninfected as a highly effective prevention strategy to contain the epidemic (Lima, 2008~ Montaner, 2010~ Velaszco- Hernandez et al., 2002). This study seeks to optimize treatment outcomes by facilitating patient-provider partnerships and treatment linkages for newly diagnosed patients new to ARVs. Working with both patients and providers, this study utilizes bio-behavioral strategies to improve engagement, treatment and retention, and to enhance patients'understanding of the role of viral suppression to improve health and reduce HIV transmission. The proposed application seeks to develop, adapt and pilot test an innovative patient-provider intervention, Conexiones y Opciones Positivas en la Argentina (Positive Connections, COPA) designed to 1) enhance HIV/ART knowledge, 2) tailor the level of information provided to patients, and 3) enhance provider-patient treatment communication. This study will enroll newly diagnosed patients new to ARVs (n = 120) and providers (n = 12) in a patient- provider intervention. Using a full factorial design, patients wil be randomized into one of four conditions: 1) Patient/Experimental - Provider/Experimental~ 2) Patient/Experimental - Provider/Standard of Care~ 3) Patient/Standard of Care - Provider/Experimental~ and 4) Patient/Standard of Care - Provider/Standard of Care. The data gathered from the four conditions will guide the development of a clinical trial to test the most efficacious patient-provider intervention with a larger, more representative sample of the target population. Utilizing the existing ARV distribution infrastructure, optimizing the synergy between patient and provider could become a critical component of adherence as an effective prevention strategy in Argentina.
Universal access to antiretroviral (ARV) medication by the Government of Argentina provides a unique opportunity to test whether such availability can favorably impact the epidemic through optimizing adherence to ARVs. This study is designed to develop, implement and test patient-provider interventions to enhance medication adherence, as well as engagement and retention in care for HIV seropositive patients new to care in Buenos Aires. The proposed study will compare the relative efficacy of three variations of patient-provider communication to the Standard of Care on ARV adherence, and engagement and retention in care in private and public clinic settings.
