Informal Caregiving & Medical Adherence Among HIV+ IDUs

描述（由申请人提供）：弱势的城市非洲裔美国人社区有不成比例的高药物滥用率和艾滋病毒/艾滋病。在艾滋病毒血清阳性的人群中，非裔美国人和药物滥用者往往有次优的医疗服务使用和药物依从性，疾病进展更快。高效抗逆转录病毒疗法的最佳使用需要在无限期的时间内几乎完全坚持，因此需要长期可持续性的行为干预。社会支持一直被发现与艾滋病毒药物依从性、卫生服务利用和其他与健康相关的行为有关。关于非正式护理的文献表明，慢性病患者的主要支持关系可能是医疗依从性干预的重要目标。本研究的目的是研究注射吸毒者（IDUs）之间的主要支持关系在促进和阻碍艾滋病毒医疗服务利用和HAART依从性方面的作用，并根据这些发现制定，试点和手工操作文化上适当的依从性促进干预措施。该研究建立在我们的研究团队之前对注射吸毒者的非正式艾滋病毒护理、社会网络、艾滋病毒依从性以及成功的预防干预研究、弱势群体的医疗依从性进行的广泛研究的基础上。大多数对慢性病患者的照顾是由家人和朋友非正式地提供的。在慢性病患者中，随着非正式护理的实施，接受工具援助与更好的医疗依从性有关。与高收入的白人相比，低收入的非洲裔美国人提供了更多的非正式（艾滋病毒）照顾，并报告了更低的与照顾相关的痛苦，但更有可能停止非正式的照顾。研究结果表明，非裔美国注射吸毒者的主要支持关系不仅是重要的支持来源，而且可能影响他们的健康相关行为。本研究以社会影响理论和网络资源交换理论为基础，采用创新的社会网络方法考察社会环境对依从性行为的影响。随着抗病毒治疗在未来几年迅速成为发展中国家艾滋病毒规划的一部分，网络方法可能是在资源匮乏环境中有效、低成本、以社区为基础的坚持治疗的可行选择。要求提供四年的经费，以便对500名感染艾滋病毒/艾滋病的前注射吸毒者和最多两名与艾滋病毒有关的主要支持者的社区样本进行四次半年度评估（n=400）。评估将包括病毒载量和CD4计数，对于一个子集，包括MEMS上限、计算机临床和医疗服务使用记录，以验证自我报告。研究结果将有助于确定行为依从性干预的适当目标和方法。

DESCRIPTION (provided by applicant): 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 years funding 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.