Motivating HIV+ Women: Risk Reduction and ART Adherence

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DESCRIPTION (provided by applicant): Women comprise the fastest growing group of persons with AIDS. They are often diagnosed later in the disease, when antiretroviral therapy (ART) is strongly indicated. Though effective in reducing the amount of circulating HIV virus and increasing the CD4 lymphocyte count, ART regimens are complex and have numerous side effects. Near perfect adherence is required to obtain and maintain the effects, but because of regimen complexities and side effects it is difficult to achieve, particularly for women who may be caretakers for HIV+ partners and children. As women on ART begin to feel better, and resume normal activities, including sexual activities, they are expected to adhere to ART and risk reduction behaviors (RRB). Reports of poor adherence to ART are common and those related to RRB are emerging. The long-term goal of this research project is to develop nursing interventions to promote adherence to both ART and RRB in HIV+ women. The primary objective of this randomized controlled behavioral trial is to test the effect of a group motivational intervention for HIV+ women on adherence to ART and RRB. The secondary objectives are to examine the mediator effects of self-efficacy, outcome expectancy, and personal goals on adherence to ART and RRB. The innovative Motivational Group (MG) intervention has motivational interviewing (MI) as the central component. It consists of 8 90-minute sessions, 2 weeks apart, led by a nurse, and is designed to inform and motivate women to adhere to ART and use RRB consistently. Using MI techniques the nurse will facilitate the group discussion relevant to ART and/or RRB adherence. Self-efficacy, positive outcome expectancy, and effective personal goals will be fostered. The intervention will be compared to an 8-session attention equivalent control condition consisting of a health promotion program led by a nurse health educator All participants wilt be assessed at five time points--baseline, immediately and 3, 6, and 9 months after the intervention using an audio computerized self-interview (ACASI). RRB adherence will be measured by self-report. Adherence to ART will be measured by self-report, eDems caps, and a Multi Component Adherence Index. Viral load and CD4 counts will be obtained by chart review at each assessment point. Repeated measures analysis of variance will be used to test the primary hypotheses that participants in the MG condition will have higher rates of adherence to ART and RRB compared to controls. Regression analyses will be used to test the effects of the mediators.