CHANGING ART ADHERENCE BEHAVIOR

改变艺术依从行为

• 批准号: 7377368
• 负责人: JEFFREY D FISHER
• 金额: $ 4.59万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7377368
• 关键词: CHANGING; ART; ADHERENCE; BEHAVIOR

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Antiretroviral therapy (ART) has enormous promise for reducing HIV-related morbidity and mortality, but ART regimens are often complex, prone to side effects, and expensive, and ART adherence is often extremely poor. The individual and public health consequences of suboptimal ART adherence are significant and include treatment failure, viral load increase, immune compromise, development of multidrug resistant (MDR) HIV, and potential transmission of drug resistant HIV to uninfected others. Although the consequences of suboptimal ART adherence are well-recognized, ART adherence promotion efforts in clinical settings are typically intermittent and ad hoc. When adherence promotion interventions are systematically implemented in clinical care settings, they almost always involve exceedingly time-, cost-, and labor-intensive one-on-one counseling procedures that cannot be widely deployed to assist substantial numbers of HIV+ patients to adhere to ART over time. Moreover, to date, relatively few theoryART adherence promotion interventions have been conducted, rigorously evaluated, and found to be effective in increasing ART adherence. The present research employs a well-validated conceptualization of health behavior change, the Information-Motivation-Behavioral Skills (IMB) model (J. Fisher & Fisher, 1992, 2000, 2002; W. Fisher & Fisher, 1993, 1999; W. Fisher et al., in press), as a basis for the design and implementation of a cost-, time- and labor-efficient, completely individualized and engaging, computer-assisted ART adherence promotion intervention. The intervention we propose will be employed on an ongoing basis in the context of routine clinical care, to teach adherence enhancement strategies to HIV+ patients about to begin ART, and to increase adherence and maintenance of adherence among HIV+ patients currently on ART. The proposed research has four specific aims: 1. We will conduct elicitation research with HIV+ patients in clinical care and with HIV care clinicians, to explore the dynamics of ART nonadherence in the HIV+ clinical population, and to identify the optimal structure and content of a theory-based, computer-assisted ART adherence intervention linked to clinical care visits. Elicitation research findings will be systematically integrated to guide the development of the intervention and to increase its ecological validity by adapting it to the dynamics of ART nonadherence among clinic patients, and to the realities of real-life clinical settings. 2. Based on elicitation research findings, guided by the IMB model, and employing motivational interviewing (MI) techniques as an intervention delivery system, we will design, pilot test, refine, and fully implement a theory-based, computer-assisted ART adherence intervention that is linked to naturally occurring HIV clinical care. 3. We will conduct rigorous intervention outcome research comparing the effects of the ART adherence intervention with an appropriate standard-of-care control group with respect to multiple measures of adherence collected over 18 months. Rates of adherence, estimated by three types of indicators (self-reports of adherence to medication, pharmacy refill records, and viral load assessments) will be collected over an 18 month period and will serve as the major outcomes of interest. We hypothesize that participants in the intervention condition will demonstrate better adherence, as defined by greater gains in absolute values of the adherence indicators noted above and by a larger proportion of participants who experience success in achieving and sustaining clinically optimal levels of adherence (e.g., ¿¿ 95%), compared to those in the control condition. Additionally, we predict that individuals who use the intervention¿ training arm component before beginning ART will demonstrate better initial degrees of adherence, compared to controls. Finally, we predict that changes in adherence as a result of the intervention will be mediated by intervention effects on ART adherence information, motivation, and behavioral skills. 4. We will use the standard-of-care control group from the intervention outcome research as a no-cost cohort for a longitudinal natural history study of ART adherence in HIV+ patients. We will test putative proximal determinants of adherence to therapy, including levels of adherence-related information, motivation, and behavioral skills. We will also test the influence on adherence of subjective and objective health status, substance use, depressed mental health functioning, changing ART regimens, development of new drugs, and other historical events that may occur over the course of the study. We hypothesize that ART adherence will be predicted longitudinally by ART adherence related information, motivation, and behavioral skills. We also hypothesize that longitudinal trends in adherence will be influenced by factors such as substance use, mental health functioning, and historical events.

该主题是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子弹和调查员（PI）可能已经从其他NIH来源获得了主要资金，因此可以在其他清晰的条目中代表。列出的机构是针对该中心的，这不是调查人员的机构。抗逆转录病毒疗法（ART）具有降低与HIV相关的发病率和死亡率的巨大希望，但是艺术方案通常很复杂，容易发生副作用且昂贵，而且艺术依从性通常非常差。次优艺术依从性的个体和公共卫生后果是显着的，包括治疗失败，病毒负荷增加，免疫妥协，多药耐药性（MDR）HIV的发展以及潜在的抗药性HIV传播给未感染的其他人。尽管次优艺术依从性的后果得到了良好的认可，但在临床环境中的艺术依从性促进工作通常是间歇性的和临时的。当在临床护理环境中系统地实施依从性促进干预措施时，它们几乎始终涉及极度的时间，成本和劳动力密集的一对一咨询程序，这些程序无法广泛部署，以帮助大量的HIV+患者随着时间的推移遵守艺术。此外，迄今为止，对相对的理论依从性促进干预措施进行了严格评估，并发现有效地增加了艺术依从性。本研究采用了对健康行为变化的验证概念化，信息动机 - 行为技能（IMB）模型（J. Fisher＆Fisher，1992，2000，2002; W. Fisher＆Fisher，1993，1999; W. Fisher等人在印刷中）的基础，以全面的方式和计算机化，并实现了计算机，并既实现了计算机，又有效率，并具有计算机 - 时间和效率的效率 - 促进干预。我们提出的干预措施将在常规临床护理的背景下持续采用，以教授即将开始艺术的HIV+患者的依从性增强策略，并提高目前目前ART上的HIV+患者的依从性和维持。拟议的研究具有四个具体目的：1。我们将向HIV+患者在临床护理和HIV护理临床医生中进行启发研究，以探索HIV+临床人群中艺术不坚持的动态，并确定基于理论的，基于理论的，计算机辅助的ART ADHERENCE干预与临床护理访问的最佳结构和内容。启发研究结果将被系统整合，以指导干预措施的发展，并通过使其适应临床患者的艺术不遵守动态以及现实生活中的临床环境，以提高其生态有效性。 2。基于IMB模型的指导，并采用动机访谈（MI）技术作为干预输送系统，我们将设计，初步测试，完善并完全实施与自然发生的HIV临床护理相关的基于理论的，基于计算机的艺术依从性干预措施。 3。我们将进行严格的干预结果研究，将ART依从性干预与适当的护理标准对照组的影响与18个月内收集的多种依从性指标相比。通过三种类型的指标（对药物的自我报告，药房补充记录和病毒负荷评估的自我报告）估算的依从性率将在18个月内收集，并将作为主要的利益结果。我们假设，处于干预条件的参与者将表现出更好的依从性，这是由上述依从性指标的绝对值提高所定义的，而与对照条件相比，在实现临床上达到和持续达到临床上最佳水平方面取得成功和维持最佳水平的参与者（例如，实现临床上最佳水平）的依从性。此外，我们预测，与对照组相比，使用干预训练部门的个人在开始艺术之前将表现出更好的初始依从性。最后，我们预测，干预措施的依从性变化将由干预对艺术依从性信息，动机和行为技能的影响介导。 4。我们将使用干预结果研究中的护理标准对照组作为HIV+患者艺术依从性的纵向自然史研究的无成本队列。我们将测试遵守治疗的推定代理决定者，包括与依从性相关的信息，动机和行为技能的水平。我们还将测试对主观和客观健康状况，药物使用，精神健康功能抑郁，不断变化的艺术方案，新药物的发展以及其他历史事件的依从性的影响。我们假设艺术依从性将通过与艺术依从性相关的信息，动机和行为技能纵向预测。我们还假设，依从性的纵向趋势将受到药物使用，心理健康功能和历史事件等因素的影响。