HIV/AIDS and Aging: A Cognitive Clinical Intervention

描述（由申请人提供）：本R21提案涉及一项探索性研究，旨在进一步开发和评价认知干预（间隔检索（SR））的使用，以改善HIV+老年人的HIV治疗依从性。有一些证据表明，认知缺陷的发生率，如执行功能障碍，可能特别高，在艾滋病毒+老年人。鉴于HAART方案的复杂性，通常在HIV+老年人中发现的认知缺陷使他们特别有可能不遵守治疗方案。Neundorfer et al.（2002）发现，外部辅助工具（如药盒、检查表、日历等）与SR策略培训（正确使用此类辅助工具）相结合，是使HIV阳性老年人达到和维持治疗目标（包括药物依从性）的有效方法，尽管执行功能存在缺陷。Joltin、Camp和McMahon发现，通过电话进行SR训练有望成为为记忆缺陷的老年人提供SR训练的另一种方式。在拟议的探索性研究中，将对60名艾滋病毒阳性老年人进行培训，结合外部援助和SR策略学习，以提高他们对艾滋病毒治疗的依从性。这些参与者中有一半将接受面对面形式的员工代表培训，另一半通过电话接受培训。每周两次，每次30分钟的培训，为期四周（8次）。据推测，至少90%的参与者将能够学习适当的策略，使他们能够在此时间范围内使用与治疗依从性相关的外部辅助工具。将在受试者初始筛选时、基线时以及培训后3个月、6个月和9个月时再次评估治疗方案依从性。如果依从性下降，将提供加强SR疗程。将在培训前和最终测试后评估临床结局（病毒载量、CD4计数）。该项目的主要目标如下：目标1：确定这种针对老年艾滋病毒感染者的SR干预措施是否可以使他们学习使用外部辅助工具以坚持治疗方案的相关策略。目标2：确定是否可以通过电话向H1V+老年人有效提供这种SR干预。目的3：确定学习使用外部辅助工具与SR干预是否与HIV+老年人的成功依从性结局相关。目的4：检查依从性结局与临床结局之间的关系，即，病毒载量和CD4计数。

DESCRIPTION (provided by applicant): This R21 proposal involves an exploratory study to further develop and evaluate the use of a cognitive intervention, spaced retrieval (SR), to improve HIV therapy adherence in HIV+ older adults. There is some evidence that the incidence of cognitive deficits such as executive dysfunction may be especially high in HIV+ older adults. Given the complexity of HAART regimens, cognitive deficits typically found in HIV+ older adults place them especially at risk for non-adherence to treatment regimens. Neundorfer et al. (2002) found that a combination of external aids such as pill boxes, checklists, calendars, etc. and SR strategy training in the appropriate use of such aids was an effective means of enabling HIV+ older adults to reach and maintain therapeutic goals, including medication adherence, in spite of deficits in executive function. Joltin, Camp, and McMahon, (in press) found that delivering SR over the telephone shows promise as an alternative means of providing SR training to older adults with memory deficits. In the proposed exploratory study, 60 HIV+ older individuals will be trained using a combination of practice with external aids and SR strategy learning to improve their adherence to HIV therapy. Half of these participants will receive SR training in a face-to-face format, the other half over the telephone. Thirty-minute training sessions will be given twice a week for four weeks (8 sessions). It is hypothesized that at least 90% of the participants will be able to learn appropriate strategies enabling them to use external aids related to therapy adherence during this time frame. Assessments of adherence to therapy regimens will be conducted at initial screening of participants, at baseline, and again at 3-month, 6-month, and 9-month intervals after training. Booster SR sessions will be provided if adherence declines. Clinical outcomes (viral load, CD4 count) will be assessed before training and at final posttest. The primary objectives of the project are as follows: Objective 1: To determine if this SR intervention for older adults with HIV can result in their learning strategies related to using external aids for adherence to treatment regimens. Objective 2: To determine if this SR intervention can be delivered effectively over the telephone to H1V+ older adults. Objective 3: To determine if learning to use external aids with this SR intervention is related to successful adherence outcomes in HIV+ older adults. Objective 4: To examine the relationships between adherence outcomes and clinical outcomes, i.e., viral load and CD4 counts.