: This is a developmental project to design and test the feasibility and preliminary efficacy of a culturally appropriate intervention for supporting antiretroviral therapy (ART) adherence in South Central China, in a resource-constrained setting where the national CDC is presently scaling up ART-treatment. We will adapt a theoretically driven ART adherence intervention, which demonstrated efficacy in a randomized clinical trial conducted in the United States, to the Chinese cultural and social context. The adaptation will be informed by the results of our preliminary quantitative and qualitative work in this region of China and will be validated by patient, provider, and community review groups. We will conduct a randomized, controlled pilot study of the feasibility and acceptability of the intervention among 90 patients beginning ART through the China national ART program in Hunan Province and establish a preliminary effect size in anticipation of a full-scale clinical trial. We will also use Ultra Deep Sequencing technology to describe baseline prevalence and incidence of genotypic ART resistance and explore the relationship between adherence and ART resistance. Knowledge acquired from this study will contribute to successful treatment of HIV disease through increased understanding of factors associated with ART adherence and interventions to support or improve adherence and through increased understanding of the clinical significance of genotypic mutations, including low abundance species, and the value of genotypic testing as part of clinical care. These benefits will accrue to patients in both the developed and developing world. The opportunity to acquire this knowledge is unique and time-limited, because China is in the early stages of an ambitious and well-organized ART roll out.

Public Health Relevance

Knowledge gained from this study will contribute to successful treatment of HIV disease around the world through increased understanding of factors associated with antiretroviral therapy (ART) adherence, interventions to improve adherence, and factors associated with resistance to ART.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
5R34MH083564-04
Application #
8074944
Study Section
Special Emphasis Panel (ZMH1-ERB-E (05))
Program Officer
Stirratt, Michael J
Project Start
2009-08-06
Project End
2014-02-28
Budget Start
2011-06-01
Budget End
2014-02-28
Support Year
4
Fiscal Year
2011
Total Cost
$167,483
Indirect Cost
Name
University of California Los Angeles
Department
Type
Schools of Nursing
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
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Xiaobai, Zou; Xi, Chen; Tian, Hongping et al. (2014) Prevalence of WHO transmitted drug resistance mutations by deep sequencing in antiretroviral-naïve subjects in Hunan Province, China. PLoS One 9:e98740
Williams, Ann B; Wang, Honghong; Burgess, Jane et al. (2013) Cultural adaptation of an evidence-based nursing intervention to improve medication adherence among people living with HIV/AIDS (PLWHA) in China. Int J Nurs Stud 50:487-94
Williams, Ann Bartley; Amico, K Rivet; Bova, Carol et al. (2013) A proposal for quality standards for measuring medication adherence in research. AIDS Behav 17:284-97
Li, Xianhong; Wang, Honghong; He, Guoping et al. (2012) Shadow on my heart: a culturally grounded concept of HIV stigma among chinese injection drug users. J Assoc Nurses AIDS Care 23:52-62
Li, Xianhong; Huang, Ling; Wang, Honghong et al. (2011) Stigma mediates the relationship between self-efficacy, medication adherence, and quality of life among people living with HIV/AIDS in China. AIDS Patient Care STDS 25:665-71