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Changing ART Adherence Behavior

改变 ART 依从行为

基本信息

批准号：
7089997
负责人：
JEFFREY D FISHER
金额：
$ 108.44万
依托单位：
UNIVERSITY OF CONNECTICUT STORRS
依托单位国家：
美国
项目类别：
财政年份：
2003
资助国家：
美国
起止时间：
2003-09-19 至 2009-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7089997
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

项目摘要

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.

当按规定服用时，抗逆转录病毒疗法（ART）对艾滋病毒阳性个体的健康和福祉具有显着影响。然而，接受抗逆转录病毒疗法的艾滋病毒阳性者必须严格遵守一种往往复杂且易产生副作用的治疗方案，以从这种疗法中获益，并避免感染可能传染给他人的耐药艾滋病毒株。虽然95%的ART依从性对于病毒抑制至关重要，但在HIV+临床样本中，60-70%或更低的实际依从率很常见。尽管对抗逆转录病毒疗法可能会对个人和公共健康产生极其严重的后果，但很少有基于理论的、经过严格评估的干预措施，以提高抗逆转录病毒疗法的依从性，并发现这些干预措施在临床护理环境中有效。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的、针对个人的干预措施，这些措施尚未证明有效性，而且过于密集和昂贵，无法广泛部署。总体而言，艾滋病毒临床环境中抗逆转录病毒治疗依从性的护理标准是临时的和最低限度的。该提案涉及一个创新的开发、试点、实施和严格评估，它使用信息-动机-行为技能（IMB）依从性模型（J. Fisher，2000 a; J. Fisher等人，2002a; W. Fisher等人，设计、实施和评估一种个性化的、交互式的、具有成本效益的、计算机辅助的ART依从性干预，该干预可以在临床护理环境中广泛实施。干预将使用动机访谈技术（例如，Rollnick等人，2000）作为一种传递系统，用于向即将开始开始ART的HIV+患者传递个体定制的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的患者传递个体定制的ART依从性相关信息、动机和行为技能（IMB）内容，以增强依从性并促进保持最佳的坚持水平。在为期18个月的随访间隔内，将ART依从性干预与适当的标准治疗对照组在ART依从性的多个指标方面进行比较。标准治疗对照组还允许我们研究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、药物滥用状态、疾病阶段、ART时间长度和其他因素的函数。这本身也是对ART依从性研究的重要贡献。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

The disclosure processes model: understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity.

DOI：
10.1037/a0018193
发表时间：
2010-03
期刊：
PSYCHOLOGICAL BULLETIN
影响因子：
22.4
作者：
Chaudoir, Stephenie R.;Fisher, Jeffrey D.
通讯作者：
Fisher, Jeffrey D.

Information-motivation-behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV+ patients in clinical care.

DOI：
10.1080/09540121003758630
发表时间：
2010-08
期刊：
AIDS care
影响因子：
1.7
作者：
Norton WE;Amico KR;Fisher WA;Shuper PA;Ferrer RA;Cornman DH;Trayling CA;Redding C;Fisher JD
通讯作者：
Fisher JD

Attrition and related trends in scientific rigor: a score card for ART adherence intervention research and recommendations for future directions.