Improving Treatment Adherence in HIV-Positive Youth Through Mindfulness Training

通过正念训练提高艾滋病毒阳性青少年的治疗依从性

基本信息

批准号：
8639485
负责人：
Erica Sibinga
金额：
$ 46.57万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-04-01 至 2018-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8639485
关键词：
21 year old Address Adherence Adolescence Adolescent and Young Adult Adult Age Anxiety Appointment Awareness Behavior Behavior Therapy Behavioral Cognitive Therapy Communities Complement Data Data Collection Effectiveness Funding Future HIV HIV Infections HIV Seropositivity Health Health education Individual Informal Social Control Intervention Measurement Mediation Meditation Mental Health Methods Morbidity - disease rate National Center for Complementary and Alternative Medicine Outcome Participant Patient Self-Report Pharmaceutical Preparations Phase III Clinical Trials Pilot Projects Process Qualitative Methods Quality of life Randomized Randomized Controlled Trials Recommendation Regimen Reporting Research Sample Size Sex Behavior Site Social Desirability Stress Techniques Thinking Training Viral Load result Youth active control arm base cognitive function compliance behavior coping design experience improved innovation interest medication compliance mindfulness mindfulness-based stress reduction mortality programs psychologic public health relevance theories therapy design transmission process treatment adherence treatment as usual young adult

项目摘要

DESCRIPTION (provided by applicant): Despite remarkable advances in HIV medication effectiveness, adherence to treatment recommendations among HIV-infected youth is alarmingly poor, resulting in preventable morbidity and mortality. Most current HIV treatment adherence interventions are designed to change thoughts and behaviors, but have limited effect on improving HIV medication adherence. Successful medication adherence relies on individuals' on-going self-regulation, an intertwined process involving coping, psychological function, and cognitive function. In this application, we propose to study the ability of mindfulness-based stress reduction (MBSR) to improve HIV-infected youth's HIV medication adherence and self-regulation. MBSR is a program of meditation techniques to enhance participants' mindfulness, or present-focused, non-judgmental awareness. Our previous research in urban youth shows that MBSR improves health-related behaviors and self-regulation. Further, preliminary data from our R21 on MBSR for stress-reduction in HIV-infected youth suggest an association between mindfulness and improved medication adherence, as well as enhanced self-regulatory processes (coping, psychological function, and cognitive function). This intervention is innovative and significant because it focuses on self-regulatory processes, and it may be used alone or as a complement to current interventions addressing specific behaviors. Building on the promising, but preliminary, findings of our R21 pilot study, this RCT will determine the effect of MBSR on HIV medication adherence (Aim 1) and self-regulation (Aim 2) among HIV-infected youth. To achieve these aims, our experienced, collaborative team will conduct a full-scale, two-site RCT with 162 HIV-infected youth 13-24 years old, comparing 1) MBSR, 2) an active control (health education program), and 3) usual care. We will determine whether group assignment predicts outcomes of interest. We will also explore: 1) associations (and potential mediation) among mindfulness, self-regulation, and medication adherence and 2) using qualitative methods, reasons for non/low-participation to inform future implementation planning. While medication adherence is our primary adherence outcome, we will also look at other HIV treatment behaviors of appointment-keeping and sex behavior. Additionally, we will employ an innovative approach to use 2 potentially-complementary methods of medication adherence data collection.

描述（由申请人提供）：尽管艾滋病毒药物治疗效果取得了显着进步，但感染艾滋病毒的青少年对治疗建议的遵守情况却极差，导致了可预防的发病率和死亡率。目前大多数艾滋病毒治疗依从性干预措施旨在改变思想和行为，但对提高艾滋病毒药物依从性的作用有限。成功的药物依从性依赖于个人持续的自我调节，这是一个涉及应对、心理功能和认知功能的相互交织的过程。在此应用中，我们建议研究基于正念的减压（MBSR）的能力，以提高感染艾滋病毒的青少年的艾滋病毒药物依从性和自我调节能力。 MBSR 是一项冥想技巧计划，旨在增强参与者的正念或专注于当下的非评判意识。我们之前对城市青年的研究表明，MBSR 可以改善与健康相关的行为和自我调节。此外，我们的 R21 关于 MBSR 用于减轻 HIV 感染青少年压力的初步数据表明，正念与改善药物依从性以及增强的自我调节过程（应对、心理功能和认知功能）之间存在关联。这种干预措施具有创新性且意义重大，因为它侧重于自我监管过程，并且可以单独使用，也可以作为当前针对特定行为的干预措施的补充。基于我们 R21 试点研究的有希望但初步的结果，该随机对照试验将确定效果 MBSR 对 HIV 感染青少年的 HIV 药物依从性（目标 1）和自我调节（目标 2）的影响。为了实现这些目标，我们经验丰富的协作团队将对 162 名 13-24 岁的 HIV 感染青少年进行全面、两地随机对照试验，比较 1) MBSR、2) 主动控制（健康教育计划）和3）平时护理。我们将确定小组分配是否可以预测感兴趣的结果。我们还将探讨：1）正念、自我调节和药物依从性之间的关联（和潜在的中介）；2）使用定性方法、不参与/低参与的原因来为未来的实施计划提供信息。虽然药物依从性是我们的主要依从性结果，但我们还将关注其他艾滋病毒治疗行为，如遵守预约和性行为。此外，我们将采用创新方法来使用两种潜在互补的药物依从性数据收集方法。