Informal Caregiving & Medical Adherence Among HIV+ IDUs

处于不利地位的市中心非裔美国人社区的物质比率高得不成比例 虐待和艾滋病毒/艾滋病。在那些艾滋病毒血清阳性的人中，非裔美国人和药物滥用者往往 医疗服务使用和服药依从性不佳，病情进展较快。 HAART的最佳使用需要无限期地几乎完全遵守，这是必要的 具有长期可持续性的行为干预。社会支持一直被发现是 与艾滋病毒用药依从性、卫生服务利用和其他与健康相关的行为有关。 有关非正式护理的文献表明，慢性病患者的主要支持关系可能很重要 医疗依从性干预的对象。拟议研究的目标是检查Main 注射吸毒者在促进和阻碍艾滋病毒医疗服务利用方面的支持性联系 和HAART遵守，并制定、试点并使符合文化标准的遵守推广 基于这些发现的干预。这项拟议的研究建立在我们研究团队广泛的先前 注射吸毒者非正式HIV照护、社会网络、HIV依从性和成功预防的研究 干预研究，弱势人群的医疗依从性。对慢性病患者最关心的是 由家人和朋友非正式地提供。在慢性病患者中，接受工具性援助，如 非正式护理是可操作的，与更好的医疗依从性相关。 与收入较高的白人相比，美国人提供更多的非正式(艾滋病毒)护理，报告的比例更低 照看相关的痛苦，但更有可能停止非正式照看。研究结果表明， 非裔美国人吸毒者的主要支持关系不仅是重要的支持来源，而且可能会影响 他们的健康相关行为。这项拟议的研究是基于社会影响力和网络理论 资源交换，并利用创新的社交网络方法来审查社会 环境对依附行为的影响。随着抗病毒疗法迅速成为艾滋病毒的一部分 在未来几年，网络方法可能是实现以下目标的可行选择 在低资源环境下有效、低成本、以社区为基础的遵从性推广。 要求对500名前吸毒者进行社区样本的四次半年度评估 艾滋病毒/艾滋病及其至多两名与艾滋病毒有关的主要支持者(n=400)。评估将包括病毒载量 和CD4计数，对于子集，MEMS CAPS、计算机化的临床和医疗服务使用记录 自我报告的验证。研究结果将有助于确定适当的目标和 行为依从性干预的途径。

Disadvantaged inner-city African American communities have disproportionately high rates of substance abuse and HIV/AIDS. Among those HIV seropositive, African Americans and substance abusers tend to have suboptimal medical service use and medication adherence and more rapid illness progression. Optimal use of HAART requires near complete adherence for an indefinite period of time, necessitating behavioral interventions with long-term sustainability. Social support has consistently been found to be associated with HIV medication adherence, health service utilization, and other health-related behaviors. Literature on informal caregiving suggests that main supportive ties of the chronically ill may be important targets of medical adherence intervention. The goals of the proposed study are to examine the role of main supportive ties among injection drug users (IDUs) in promoting and impeding HIV medical service utilization and HAART adherence, and to develop, pilot, and manualize a culturally appropriate adherence promotion intervention based on these findings. The proposed study builds on our research team's extensive prior research on IDUs' informal HIV caregiving, social networks, HIV adherence, and successful prevention intervention research, medical adherence in vulnerable populations. Most care for the chronically ill is provided informally by family and friends. Among the chronically ill, receipt of instrumental assistance, as informal care is operationalized, is associated with better medical adherence. Low income African Americans compared to higher income whites provide more informal (HIV) caregiving and report lower caregiving-related distress, yet are more likely to cease informal caregiving. Findings have demonstrated that African American IDUs' main supportive ties are not only important sources of support but may influence their health-related behaviors. The proposed study is based on theories of social influence and network resource exchange and utilizes an innovative social network approach to the examination of social environmental influences on adherence behaviors. As antiviral therapies rapidly begin to become part of HIV programs in developing countries over the next few years, network approaches may be viable options for effective, low cost, community-based adherence promotion in low resource settings. Four yearsfunding is requested for four semi-annual assessments of a community sample of 500 former IDUs living with HIV/AIDS and up to two of their main HIV-related supporters (n=400). Assessments will include viral load and CD4 count, and for a subset, MEMS caps, computerized clinical, and medical service use records for validation of self-reports. Study findings will contribute to the identification of appropriate targets and approaches for the behavioral adherence intervention.