Changing ART Adherence Behavior

改变 ART 依从行为

• 批准号: 6800842
• 负责人: JEFFREY D FISHER
• 金额: $ 130.97万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-19 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6800842
• 关键词: AIDS therapy; DVD /CD ROM; HIV infections; behavior therapy; behavioral /social science research tag; clinical research; computer assisted instruction; health behavior; human subject; human therapy evaluation; longitudinal human study; motivation; patient oriented research; questionnaires; therapy compliance

When taken as prescribed, antiretroviral therapy (ART) has dramatic effects on the health and well-being of HIV+ individuals. HIV+ persons on ART, however, must adhere rigorously to an often complex and side-effect prone therapeutic regimen to benefit from this therapy, and to avoid contracting treatment resistant strains of HIV that can potentially be transmitted to others. While 95% adherence to ART is critical for viral suppression, actual adherence rates of 60-70% and lower are common in HIV+ clinical samples. Although suboptimal adherence to ART may have extremely serious individual and public health consequences, few theory-based, rigorously evaluated interventions to increase adherence to ART have been implemented and found to be effective in clinical care settings. Most extant approaches to enhancing adherence to ART involve labor-intensive, individually focused interventions, which have yet to demonstrate efficacy, and which are too intensive and too expensive to deploy widely. Overall, the standard-of-care for ART adherence in HIV clinical settings is ad hoc and minimal. This proposal involves the development, piloting, implementation, and rigorous evaluation of an innovative approach to assisting HIV+ individuals to adhere to ART. It uses the Information - Motivation - Behavioral Skills (IMB) model of adherence (J. Fisher, 2000a; J. Fisher et al., 2002a; W. Fisher et al., in press) to design, implement and evaluate an individualized, interactive, cost-effective, computer-assisted ART adherence intervention that can be widely implemented in clinical care settings. The intervention will use Motivational Interviewing techniques (e.g., Rollnick et al., 2000) as a delivery system for conveying individually tailored ART adherence-related information, motivation, and behavioral skills (IMB) content to HIV+ patients about to begin ART, to facilitate high levels of initial adherence, and to patients on ART, to enhance adherence and promote maintenance of optimal levels of adherence. The ART adherence intervention will be compared with an appropriate standard-of-care control group in terms of mutiple indicators of ART adherence in evaluation outcome research over an 18-month follow-up interval. The standard-of-care control group will also permit us to study the natural history of ART adherence and its longitudinal dynamics, as a function of factors such as changes in subjective and objective health, substance abuse status, disease stage, length of time on ART, and other factors. This, in its own right, also represents an important contribution to ART adherence research.

按照规定，抗逆转录病毒疗法（ART）对HIV+个体的健康和福祉产生巨大影响。然而，艾滋病毒+人必须严格地遵守一种经常复杂且副作用易于治疗方案，以使这种疗法受益，并避免可能会传播给他人的抗体治疗抗药性HIV菌株。虽然对ART的依从性为95％对于病毒抑制至关重要，但在HIV+临床样本中，实际依从率为60-70％及以下。虽然次优的依从性 艺术可能会带来极为严重的个人和公共卫生后果，很少有基于理论的，严格评估的干预措施可以提高对艺术的依从性，并发现在临床护理环境中有效。增强对艺术的依从性的大多数现存方法都涉及劳动密集型，个人专注的干预措施，这些干预措施尚未证明疗效，并且过于密集且过于昂贵，无法广泛部署。总体而言，在HIV临床环境中，ART依从性的护理标准是临时且最少的。该建议涉及创新的开发，试点，实施和严格评估 协助艾滋病毒+个人遵守艺术的方法。它使用依从性的信息 - 动机 - 行为技能（IMB）模型（J. Fisher，2000a; J. Fisher等，2002a; W. Fisher等人，印刷中）的设计，实施和评估可以在临床护理设置中实施的个性化，交互式，成本效益，计算机辅助，计算机辅助的艺术依从性介入。 The intervention will use Motivational Interviewing techniques (e.g., Rollnick et al., 2000) as a delivery system for conveying individually tailored ART adherence-related information, motivation, and behavioral skills (IMB) content to HIV+ patients about to begin ART, to facilitate high levels of initial adherence, and to patients on ART, to enhance adherence and promote 维持最佳依从性水平。在18个月的随访间隔中，将ART依从性干预与适当的护理标准对照组相提并论。护理标准对照组还将允许我们研究艺术依从性及其纵向动力学的自然历史，这是诸如主观和客观健康，药物滥用状态，疾病阶段，艺术上的时间长度和其他因素等因素的函数。这本身也代表了对艺术依从性研究的重要贡献。