The development and validation of a scale to measure Treatment Regimen Fatigue among older adults living with HIV

衡量老年艾滋病毒感染者治疗方案疲劳程度的量表的开发和验证

• 批准号: 10545951
• 负责人: Tiarney D Ritchwood
• 金额: $ 58.96万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10545951
• 关键词: AIDS/HIV problem; Adult; Aging; Behavior Therapy; Behavioral; Biological Markers; CD4 Lymphocyte Count; Characteristics; Chronic; Clinic; Clinical; Clinical assessments; Communities; Comprehension; Data; Development; Disease; Disease Management; Distress; Elderly; Ensure; Epidemiologic Monitoring; Evaluation; Fatigue; Geriatric Assessment; Goals; HIV; Health; Hospitals; Incidence; Interruption; Intervention; Intervention Studies; Interview; Knowledge; Life; Link; Measures; Methodology; Methods; Modeling; Morbidity - disease rate; North Carolina; Outcome; PF4 Gene; Patient-Focused Outcomes; Patients; Persons; Polypharmacy; Population; Prevalence; Prevention; Psychometrics; Quality of life; Regimen; Reporting; Research; Resources; Risk; Self Management; Source; Surveys; Symptoms; Tablets; Testing; Translating; Treatment Protocols; Validation; Validity and Reliability; Viral Load result; Viremia; Visit; Work; Workload; age related; aged; base; biopsychosocial; biopsychosocial factor; blood pressure elevation; care outcomes; clinical care; clinical center; clinical practice; cognitive interview; cohort; compliance behavior; coping; design; experience; improved; improved outcome; innovation; insight; instrument; method development; mortality; multidisciplinary; multiple chronic conditions; novel; patient oriented; patient population; peer; person centered; pill; psychosocial; response; sex; social interventions; stressor; theories; therapy development; tool; treatment adherence; treatment comparison

ABSTRACT This application is in response to PAR-21-068 Multidisciplinary Studies of HIV/AIDS and Aging, as well as NOSI (NOT-OD-21-100) Improving Patient Adherence to Treatment and Prevention Regimens. By 2030, older (aged 50+ years) people living with HIV (PLWH) will comprise 73% of all PLWH. Despite advances in HIV treatment, older PLWH remain at elevated risk for early morbidity and mortality compared to their peers without HIV due to the cumulative impact of HIV disease, multimorbidity, and biopsychosocial challenges on disease management. Treatment regimen/disease-specific fatigue (TRDF)—distress associated with living with, managing, or coping with a chronic condition, its symptoms and/or treatments—is a key barrier to disease management among people with chronic conditions. Previous studies estimate that TRDF impacts 33-65% of all PLWH. True values, however, are unknown, as there is no comprehensive, reliable, and valid tool to assess it. Much of our TRDF knowledge is derived from 1) studies assessing TRDF with single items; 2) qualitative data from younger, healthier PLWH; 3) tools that do not fully capture TDRF and its defining characteristics, such as imbalance between patient workload and patient capacity; and 4) data from studies conducted prior to the advent of single- tablet regimens. A comprehensive TRDF tool would enable us to identify modifiable drivers of TDRF that could enable epidemiologic surveillance, inform geriatric assessments, and guide intervention development. Guided by our novel conceptual model integrating the Workload Capacity Model and Cumulative Complexity Theory and building on our preliminary work, the goal of this study is to design and validate a comprehensive tool to assess TRDF and identify modifiable factors to facilitate its treatment among older English- and Spanish-speaking TRDF among older PLWH with multimorbidity and to refine our novel conceptual model suggest links between TRDF and poor clinical outcomes, including HIV treatment interruption and unsuppressed viremia. Among those with multimorbidity, evidence of poor self-management of the co-occurring condition(s) was observed (e.g., high A1C and/or elevated blood pressure at most recent visit) among those reporting greater disease workload and lower capacity. Interviews with HIV clinicians suggested that older PLWH may be more susceptible to TRDF than younger PLWH, and clinicians reported a lack of knowledge and resources regarding TRDF. Our findings highlight PLWH with multimorbidity. Preliminary data from our mixed methods study to elicit information about an urgent need to develop a tool to assess TRDF among older PLWH and assist clinicians with identifying person-centered interventions to mitigate its effects on disease management. To do this, we will leverage secondary data from previous work to inform the design of English and Spanish versions of our TRDF instruments (Aim 1A), which we will then pre-test (Aim 1B. We will then conduct a psychometric study to validate both versions using rigorous survey development methods, and test our novel conceptual model (Aim 2).

抽象的 此申请是为了响应 PAR-21-068 HIV/AIDS 和老龄化的多学科研究以及 NOSI (NOT-OD-21-100) 到 2030 年，提高老年患者对治疗和预防方案的依从性。 尽管艾滋病毒治疗取得了进展，但 50 岁以上的艾滋病毒感染者 (PLWH) 将占所有 PLWH 的 73%。 与未感染艾滋病毒的同龄人相比，老年感染者早期发病和死亡的风险仍然较高，原因是 HIV 疾病、多发病和生物心理社会挑战对疾病管理的累积影响。 治疗方案/疾病特异性疲劳 (TRDF)——与生活、管理或应对相关的痛苦 对于慢性病，其症状和/或治疗是人们疾病管理的一个关键障碍 先前的研究估计 TRDF 影响 33-65% 的 PLWH 真实值。 然而，这些都是未知的，因为没有全面、可靠和有效的工具来评估我们的大部分 TRDF。 知识源自 1) 使用单个项目评估 TRDF 的研究 2) 来自年轻人的定性数据； 更健康 感染者和艾滋病患者； 3) 工具不能完全捕捉 TDRF 及其定义特征，例如不平衡 患者工作量和患者容量之间的关系；4) 数据来自于单一技术出现之前进行的研究 片剂疗法。 全面的 TRDF 工具将使我们能够识别可修改的 TDRF 驱动程序，这些驱动程序可以 实现流行病学监测、为老年评估提供信息并指导干预措施的制定。 通过我们集成工作负载容量模型和累积复杂性理论的新颖概念模型 在我们的前期工作的基础上， 本研究的目标是设计和验证 综合评估工具 TRDF 并确定可修改的因素，以促进英语和西班牙语老年人的治疗 TRDF 在患有多种疾病的老年 PLWH 中进行研究并完善我们的新概念模型表明 TRDF 之间的联系 临床结果不佳，包括艾滋病毒治疗中断和病毒血症未受抑制。 多发病，观察到对同时发生的病症的自我管理不佳的证据（例如，高 A1C 和/或最近一次就诊时血压升高），其中报告疾病工作量较大且较低 对 HIV 参议员的采访表明，老年 PLWH 可能比 TRDF 更容易受到影响。 年轻的感染者和参议员报告称缺乏有关 TRDF 的知识和资源。 强调 来自我们混合方法研究的初步数据，以获取有关多种疾病的信息。 迫切需要开发一种工具来评估老年 PLWH 中的 TRDF 并协助参议员 确定以人为本的干预措施，以减轻其对疾病管理的影响。 利用之前工作中的二手数据为 TRDF 的英语和西班牙语版本的设计提供信息 工具（目标 1A），然后我们将对其进行预测试（目标 1B。然后我们将进行心理测量研究以验证 两个版本都使用严格的调查开发方法，并测试我们新颖的概念模型（目标 2）。