CLINICAL AND PSYCHOSOCIAL INFLUENCES ON HIV THERAPY

描述(申请人摘要)：新的和仍在发展中的抗病毒药物 治疗艾滋病毒的药物在减少病毒载量方面取得了初步成功， 逆转了一些患者不可阻挡的临床进程。这个 使用--这些药物的有效性及其对人体和人类健康的影响 艾滋病的流行，将不仅仅取决于药理学和分子生物学 因素(例如，药物耐受性、长期副作用、抗药性) 但也取决于经济、文化和社会因素(例如，获得和 可用性、合规性、风险行为的变化、风险的变化 社交网络的配置，以及这些因素的演变)。 传统上，诊所无法评估后一种因素， 因为他们的结构不是为了进行家访、外展或评估 病人的社会背景。在这项研究中，研究人员建议 考察社会网络因素对人类自然历史的影响 抗病毒药物的使用，以及这些药物对儿童的使用效果 关于个人健康和疾病传播的可能性。这个 社会网络因素(风险配置、稳定性、结构、 成分、强度和密度)将同时考虑 与其他关键的流行病学、临床和心理学的作用 各种因素。将研究四组人：第一组(n=180)-- 在诊所确诊的接受抗病毒治疗的人 (HIV+)；第二组(n=60)--在诊所确诊的 有可能有资格接受抗病毒治疗，但目前没有接受 (HIV+)；第三组(n=60)--在社区中被确定为 感染艾滋病毒的人，诊所可以为他们提供服务，但不使用 未接受抗病毒治疗的门诊患者；第IV组(n=60)-- 在社区中确定了哪些人具有人口统计学和行为 特征与第三组相似，但未感染 爱滋病毒。来自临床和实验室评估的信息，来自 心理面谈和测试，以及现场外展评估， 这包括使用人种学和社会网络分析 定义社会环境的技术，将被收集。每个人 每隔6个月接受一次面谈，共四次面谈。 收集到的信息将用于评估社交网络的作用 论潜在混杂情况下的药物依从性 流行病学、临床和心理因素。因此，这项研究将 提供有关各种因素的信息--两者都是在 传统上不适用于临床--这可能会影响 抗病毒药物使用的自然历史，并将作为基础 综合评估有效性和设计潜力 干预措施。

DESCRIPTION (Applicant's Abstract): The new and still evolving antiviral agents for HIV have demonstrated early success in reducing viral load and reversing an inexorable clinical course in some patients. The use-effectiveness of these drugs, and their impact on persons and on the AIDS epidemic, will depend not only on pharmacologic and molecular biologic factors (e.g., drug tolerance, longer term side effects, drug resistance) but on economic, cultural, and social factors as well (e.g., access and availability, compliance, changes in risk behavior, changes in the risk configuration of social networks, and the evolution of these factors). Traditionally, clinics are not in a position to assess the latter factors, since they are not structured to make home visits, do outreach, or evaluate patients' social context. In this study, the investigators propose to examine the influence of social network factors on the natural history of antiviral drug use, and on the use-effectiveness of these agents on the health of individuals and on the probability of disease transmission. The role of social network factors (risk configuration, stability, structure, composition, the strength and density) will be considered simultaneously with the role of other critical epidemiological, clinical, and psychological factors. Four groups of persons will be studied: Group I (n=180) -- persons ascertained in the clinic who are placed on antiviral therapy (HIV+); Group II (n=60) -- persons ascertained in the clinic who are potentially eligible for, but are not currently receiving, antiviral therapy (HIV+); Group III (n=60) -- persons ascertained in the community who are infected with HIV, for whom the clinic is available, but who do not use the clinic and are not on antiviral therapy; Group IV (n=60)-- persons ascertained in the community who have demographic and behavioral characteristics similar to those in Group III, but who are not infected with HIV. Information from clinical and laboratory assessments, from psychological interviews and tests, and from field outreach assessment, which includes using both ethnographic and social network analysis techniques to define the social environment, will be collected. Each person will be interviewed at 6-month intervals, for a total of four interviews. The collected information will be used to assess the role of social networks on drug adherence in the presence of potentially confounding epidemiological, clinical, and psychological factors. The study will thus provide information about a variety of factors -- both measured in the clinic and traditionally not available to the clinic -- that can influence the natural history of antiviral drug use, and will serve as a basis for comprehensive assessment of effectiveness and for the design of potential interventions.