Changing Antiretroviral Therapy Adherence Behavior

改变抗逆转录病毒治疗的依从行为

• 批准号: 6654781
• 负责人: JEFFREY D FISHER
• 金额: $ 134.12万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-19 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6654781
• 关键词: AIDS therapy; DVD /CD ROM; HIV infections; behavior therapy; behavioral /social science research tag; clinical research; computer assisted instruction; health behavior; human subject; human therapy evaluation; longitudinal human study; motivation; patient oriented research; questionnaires; therapy compliance

When taken as prescribed, antiretroviral therapy (ART) has dramatic effects on the health and well-being of HIV+ individuals. HIV+ persons on ART, however, must adhere rigorously to an often complex and side-effect prone therapeutic regimen to benefit from this therapy, and to avoid contracting treatment resistant strains of HIV that can potentially be transmitted to others. While 95% adherence to ART is critical for viral suppression, actual adherence rates of 60-70% and lower are common in HIV+ clinical samples. Although suboptimal adherence to ART may have extremely serious individual and public health consequences, few theory-based, rigorously evaluated interventions to increase adherence to ART have been implemented and found to be effective in clinical care settings. Most extant approaches to enhancing adherence to ART involve labor-intensive, individually focused interventions, which have yet to demonstrate efficacy, and which are too intensive and too expensive to deploy widely. Overall, the standard-of-care for ART adherence in HIV clinical settings is ad hoc and minimal. This proposal involves the development, piloting, implementation, and rigorous evaluation of an innovative approach to assisting HIV+ individuals to adhere to ART. It uses the Information - Motivation - Behavioral Skills (IMB) model of adherence (J. Fisher, 2000a; J. Fisher et al., 2002a; W. Fisher et al., in press) to design, implement and evaluate an individualized, interactive, cost-effective, computer-assisted ART adherence intervention that can be widely implemented in clinical care settings. The intervention will use Motivational Interviewing techniques (e.g., Rollnick et al., 2000) as a delivery system for conveying individually tailored ART adherence-related information, motivation, and behavioral skills (IMB) content to HIV+ patients about to begin ART, to facilitate high levels of initial adherence, and to patients on ART, to enhance adherence and promote maintenance of optimal levels of adherence. The ART adherence intervention will be compared with an appropriate standard-of-care control group in terms of mutiple indicators of ART adherence in evaluation outcome research over an 18-month follow-up interval. The standard-of-care control group will also permit us to study the natural history of ART adherence and its longitudinal dynamics, as a function of factors such as changes in subjective and objective health, substance abuse status, disease stage, length of time on ART, and other factors. This, in its own right, also represents an important contribution to ART adherence research.

如果按处方服用，抗逆转录病毒治疗 (ART) 对 HIV 阳性个体的健康和福祉具有显着影响。然而，接受抗逆转录病毒治疗的艾滋病病毒感染者必须严格遵守通常复杂且容易产生副作用的治疗方案，才能从这种治疗中受益，并避免感染可能传播给他人的治疗耐药性艾滋病毒株。虽然 95% 的 ART 依从率对于抑制病毒至关重要，但 HIV+ 临床样本中的实际依从率通常为 60-70% 或更低。尽管遵守程度不理想 ART 可能会对个人和公共卫生造成极其严重的后果，但很少有基于理论的、经过严格评估的干预措施来提高 ART 的依从性，并且在临床护理环境中已被实施并被发现是有效的。大多数现有的提高抗逆转录病毒疗法依从性的方法都涉及劳动密集型、以个人为重点的干预措施，这些干预措施尚未显示出有效性，而且强度太大、成本太高，无法广泛部署。总体而言，HIV 临床环境中 ART 依从性的护理标准是临时且最低限度的。该提案涉及创新的开发、试点、实施和严格评估 帮助 HIV+ 个体坚持 ART 的方法。它使用信息 - 动机 - 行为技能 (IMB) 依从性模型（J. Fisher, 2000a; J. Fisher et al., 2002a; W. Fisher et al., in press）来设计、实施和评估个性化、交互式、经济高效、计算机辅助的 ART 依从性干预措施，该干预措施可以在临床护理环境中广泛实施。该干预措施将使用动机访谈技术（例如，Rollnick 等人，2000）作为传递系统，向即将开始 ART 的 HIV+患者传达个性化的 ART 依从性相关信息、动机和行为技能（IMB）内容，以促进高水平的初始依从性，并向接受 ART 的患者传达个性化的 ART 依从性相关信息、动机和行为技能（IMB）内容，以提高依从性并促进 维持最佳的依从性水平。在 18 个月的随访时间间隔内，在评估结果研究中，将 ART 依从性干预措施与适当的护理标准对照组进行比较，以评估 ART 依从性的多项指标。标准护理对照组还将使我们能够研究 ART 依从性的自然史及其纵向动态，作为主观和客观健康变化、药物滥用状况、疾病阶段、ART 时间长度和其他因素等因素的函数。这本身也代表了对 ART 依从性研究的重要贡献。