PEER EDUCATION AND ADHERENCE TO HIV THERAPY IN CHILDREN

描述(摘自摘要)：艾滋病毒的巨大进步 最近发生的临床护理将极大地造福于艾滋病毒感染者 无论是孩子还是成年人。然而，新药显著提高了疗效。 而联合使用的较老的抗逆转录病毒药物依赖于严格的 患者坚持接受治疗。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为期36个月的跟踪调查 开始或接受高效抗逆转录病毒治疗(HAART) 三个特工。遵从率和遵从性差的模式将是 使用药物事件监控系统(MEMS)跟踪盖帽确定，a 药物瓶盖，内含微电子设备，可记录每次 瓶子被打开了。首席调查员假设遵守 最初随访期内的比率将由照顾者和 基线时的儿童决定因素，通过结构化访谈和 标准的心理工具。这些包括：儿童的严重程度 疾病；用药史；当前用药方案的持续时间； 照顾者、儿童和家庭人口学；照顾者艾滋病毒知识； 养生方案的复杂性；护理者的健康信念；护理者的社会 支持；育儿压力；照顾者精神症状；以及孩子 苦恼。调查人员进一步假设，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 对依从率的影响。这些中介因素将被衡量 在学习过程中定期进行。在最初的后续行动期间， 家庭将接受多学科门诊的“标准护理” 优化护理、社会工作和精神方面的依从性的方法 医疗服务。经过六个月的随访，每月有一位同伴健康 将增加教育者家访干预，旨在提高遵从性 通过识别门诊患者中不明显的障碍，提高超过基线的比率 诊所设置，提高照顾者知识，并影响其他 中介因素。将增加对家庭的密集干预 在增加了家访后，反复坚持的情况 干预。强化干预将包括每周同伴健康 教育者家访和个性化心理健康服务。穿过 黏附数据与周期性病毒血浆RNA定量的相关性 在临床护理过程中获得的依从率 维持临床相关的抗病毒作用将被定义。一个 将建立和维护生物库，以便未来 研究可能定义服药依从性和模式的变化 导致病毒抵抗力发展的变化。

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.