PEER EDUCATION AND ADHERENCE TO HIV THERAPY IN CHILDREN

描述（改编自摘要）：艾滋病毒的巨大进步 最近出现的临床护理将大大有利于艾滋病毒感染者， 儿童以及成人。 然而，新的药物的疗效显著增加， 和较老的抗逆转录病毒药物联合使用依赖于严格的 患者对治疗的依从性。 在这项研究中，研究人员将招募和 对80名围产期感染艾滋病毒的儿童进行了为期36个月的随访， 开始或接受高效抗逆转录病毒治疗（HAART）， 三个特工 依从率和依从性差的模式将 使用药物事件监测系统（MEMS）跟踪帽确定， 含有微电子器件的药物瓶盖， 瓶子打开了。 主要研究者假设依从性 初始随访期间的发生率将由护理人员预测， 基线时的儿童决定因素，采用结构化访谈进行测量， 标准的心理仪器。 这些问题包括：儿童的严重性 疾病;用药史，当前用药方案的持续时间; 照顾者、儿童和家庭人口统计资料;照顾者艾滋病毒知识; 方案复杂性;照顾者健康信念;照顾者社会 支持;养育压力;照顾者精神症状;和儿童 痛苦 研究者进一步假设，这些变化 随着时间的推移，基线决定因素将起到中介因素的作用， 影响到遵守率。 这些中介因素将被测量 在研究过程中定期进行。 在最初的随访期间， 家庭将获得“标准护理”门诊多学科 方法，以优化涉及护理，社会工作和心理坚持 保健服务 经过六个月的随访，每月进行一次同伴健康调查。 将增加教育者家访干预，旨在提高依从性 通过确定门诊患者中不明显的障碍， 诊所设置，提高护理人员的知识，并影响其他 中介因素。 将为家庭增加一项强化干预措施 增加家访后依从性反复差 干预 强化干预将包括每周同伴健康 教育家家访和个性化的心理健康服务。 通过 粘附数据与定期病毒血浆RNA定量的相关性 在临床护理过程中获得， 维持临床相关的抗病毒作用。 一 将建立和维护生物储存库，以便将来 研究可以定义药物依从性的改变和 导致病毒耐药性发展的改变。

DESCRIPTION (adapted from the Abstract): The dramatic advances in HIV clinical care which have occurred recently will greatly benefit HIV-infected children as well as adults. However, the markedly increased efficacy of new and older antiretroviral agents used in combination is dependent on strict patient adherence to therapy. In this study the researchers will enroll and follow, for a 36-month period, 80 perinatally HIV-infected children who are beginning or receiving highly active antiretroviral therapy (HAART) with three agents. Adherence rate and patterns of poor adherence will be determined utilizing Medication Event Monitoring System (MEMS) Track Caps, a medication bottle cap containing microelectronics that record each time the bottle is opened. The Principal Investigator hypothesizes that adherence rate during an initial follow-up period will be predicted by caregiver and child determinants at baseline, measured with structured interview and standard psychological instruments. These include: severity of child's illness; medication history, duration of the current medication regimen; caregiver, child, and family demographics; caregiver HIV knowledge; complexity of the regimen; caregiver health beliefs; caregiver social support; parenting stress; caregiver psychiatric symptoms; and child distress. The Investigator hypothesizes, further, that changes in these baseline determinants over time will function as mediating factors and impact upon the adherence rate. These mediating factors will be measured periodically over the course of study. During the initial follow-up period, families will receive a "standard of care" outpatient multidisciplinary approach to optimize adherence involving nursing, social work, and mental health services. After six months of follow-up, a monthly peer health educator home visit intervention will be added designed to improve adherence rate over baseline by identifying barriers not apparent in the outpatient clinic setting, enhancing caregiver knowledge, and influencing other mediating factors. An intensive intervention will be added for families with repeated poor adherence after the addition of the home visit intervention. The intensive intervention will include weekly peer health educator home visits and individualized mental health services. Through correlation of adherence data with periodic viral plasma RNA quantitation obtained in the course of clinical care, the adherence rate necessary to maintain a clinically relevant antiviral effect will be defined. A biological repository will be established and maintained, so that future studies may define the alteration in medication adherence and patterns of alteration that lead to development of viral resistance.