Protocol of a randomized controlled trial to test the effects of client-centered Representative Payee Services on antiretroviral therapy adherence among marginalized people living with HIV

BMC Public Health

Elizabeth Hagan¹  Karen Musgrove²  Abisola Olaniyan³  Mary Hawk³  Stephanie L. Creasy³  Catherine Maulsby⁴  D. Scott Batey⁵  Deborah Martin⁶  Courtenay Sashin⁶  Maria Mori Brooks⁶  Christina Farmartino⁷ 

[1] Action Wellness, Philadelphia, PA, USA;Birmingham AIDS Outreach, Birmingham, AL, USA;Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, 15261, Pittsburgh, PA, USA;Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA;Epidemiology Data Center, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA;The Open Door, Inc., Pittsburgh, PA, USA;

关键词: Randomized controlled trial;    CCRP;    Representative payee;    Client-centered;    Harm reduction;    PLWH;    HIV;    Antiretroviral therapy adherence;    Social Security Administration;   

DOI  :  10.1186/s12889-020-09500-z

来源: Springer

【 摘 要 】

BackgroundClient-Centered Representative Payee (CCRP) is an intervention modifying implementation of a current policy of the US Social Security Administration, which appoints organizations to serve as financial payees on behalf of vulnerable individuals receiving Social Security benefits. By ensuring beneficiaries’ bills are paid while supporting their self-determination, this structural intervention may mitigate the effects of economic disadvantage to improve housing and financial stability, enabling self-efficacy for health outcomes and improved antiretroviral therapy adherence. This randomized controlled trial will test the impact of CCRP on marginalized people living with HIV (PLWH). We hypothesize that helping participants to pay their rent and other bills on time will improve housing stability and decrease financial stress.MethodsPLWH (n = 160) receiving services at community-based organizations will be randomly assigned to the CCRP intervention or the standard of care for 12 months. Fifty additional participants will be enrolled into a non-randomized (“choice”) study allowing participant selection of the CCRP intervention or control. The primary outcome is HIV medication adherence, assessed via the CASE adherence index, viral load, and CD4 counts. Self-assessment data for ART adherence, housing instability, self-efficacy for health behaviors, financial stress, and retention in care will be collected at baseline, 3, 6, and 12 months. Viral load, CD4, and appointment adherence data will be collected at baseline, 6, 12, 18, and 24 months from medical records. Outcomes will be compared by treatment group in the randomized trial, in the non-randomized cohort, and in the combined cohort. Qualitative data will be collected from study participants, eligible non-participants, and providers to explore underlying mechanisms of adherence, subjective responses to the intervention, and implementation barriers and facilitators.DiscussionThe aim of this study is to determine if CCRP improves health outcomes for vulnerable PLWH. Study outcomes may provide information about supports needed to help economically fragile PLWH improve health outcomes and ultimately improve HIV health disparities. In addition, findings may help to refine service delivery including the provision of representative payee to this often-marginalized population. This protocol was prospectively registered on May 22, 2018 with ClinicalTrials.gov (NCT03561103).

【 授权许可】

CC BY