Improving the self-report of medication adherence problems in HIV

描述(由申请人提供)：尽管艾滋病毒每天治疗一次，但对艾滋病毒抗逆转录病毒疗法(ART)的依从性很差，显然仍很普遍。同样清楚的是，糖尿病和心血管疾病等非传染性共病在艾滋病毒携带者中越来越常见，针对这些其他疾病所需的药物使患者的坚持努力进一步复杂化。不幸的是，临床医生和研究人员还没有开发出廉价和准确的方法来诊断药物依从性问题。目的电子数据监测等方法昂贵且不适用于临床，且很少有成熟、规范、准确的自我报告服药依从性的方法。我们无法通过自我报告准确地评估依从性是一个重要的问题，因为在我们能够准确地诊断依从性问题之前，对于患者的所有药物，不可能集中干预措施来改善那些最需要的人的依从性。这项研究的长期目标是将对药物依从性问题的准确和及时诊断与针对患者和药物的定制治疗联系起来。这项应用的总体目标是开发一小套经过良好测试的项目，临床医生和研究人员可以使用这些项目来诊断艾滋病毒携带者的用药依从性问题。我们的中心假设是，他们估计，患者在自我报告时通常不记得个别剂量事件。我们认为，我们计划的严格认知测试将产生与患者用来回忆和报告依从性事件的实际认知过程一致的问卷项目，因此将是最准确的。选择这种方法的理由是，心理学家和认知科学家使用的方法的应用来理解信息是如何编码和回忆的，将为药物自我报告科学提供新的见解，并为临床医生和研究人员提供重要的新工具。这项拟议的研究与美国国立卫生研究院的使命相关，针对艾滋病毒等慢性疾病的药物依从性不佳是一个严重的世界性问题，因为准确识别药物依从性问题是有效干预的先决条件。在较强的初步数据指导下，R01建议有三个具体目标：1)使用深度认知测试来开发最优的药物自我报告项目集，2)进行心理测量测试，3)进行结构效度测试。这种方法是创新的，因为严格的认知测试尚未用于优化遵从性自我报告的质量。这项拟议的研究意义重大，因为临床护理和研究都迫切需要有效、标准化的项目来自我报告患者的所有药物治疗依从性。虽然这项建议的重点是艾滋病毒患者，因为我们的测试将专注于抗逆转录病毒治疗和其他非抗逆转录病毒药物，但我们的发现应该适用于所有慢性病患者。 公共卫生相关性：要使艾滋病毒携带者获得最佳健康结果，他们不仅要坚持服用抗逆转录病毒药物，而且要坚持治疗糖尿病等非传染性疾病的药物。我们建议开发和验证一小部分自我报告项目，这些项目可以用来识别有遵守问题的人，以便他们能够有效地成为干预的目标。虽然这项建议主要针对艾滋病患者，但我们开发的项目应该可用于任何慢性病患者的服药依从性评估。

DESCRIPTION (provided by applicant): Despite the availability of one pill once daily treatment for HIV, poor adherence with HIV antiretroviral therapy (ART) clearly continues to be widespread. It is also clear that non-infectious comorbidity such as diabetes and cardiovascular disease is increasingly common in persons with HIV, and that medications required for these other conditions further complicate patients' adherence efforts. Unfortunately, clinicians and researchers have yet to develop inexpensive and accurate methods to diagnose medication adherence problems. Objective methods such as electronic data monitoring are expensive and impractical in clinical care, and there are few well-tested, standardized, accurate methods for self report of medication adherence. Our inability to accurately assess adherence by self report is an important problem, because until we can accurately diagnose adherence problems, for all of a patient's medications, it will not be possible to focus interventions to improve adherence on those who most need them. The long term goal of this research is to link the accurate and timely diagnosis of medication adherence problems with customized treatments that are patient and medication specific. The overall objective of this application, which is the next step toward attainment of our long term goal, is to develop a small set of well-tested items that can be used by clinicians and researchers to diagnose medication adherence problems in persons with HIV. Our central hypothesis is that patients usually cannot remember individual dosing events when they self-report, they estimate. We argue that the rigorous cognitive testing that we plan will produce questionnaire items that are congruent with the actual cognitive processes which patient use to recall and report adherence events, and will thus be optimally accurate. The rationale for choosing this approach is that that the application of methods used by psychologists and cognitive scientists to understand how information is encoded and recalled will provide new insights to the science of medication self-report, and provide important new tools for both clinicians and researchers. The proposed research is relevant to the NIH's mission poor adherence with medications for chronic conditions like HIV is a serious, worldwide problems, and because the accurate identification of medication adherence problems is a precondition for efficient and effective intervention. Guided by strong preliminary data, this R01 proposal has three specific aims: 1) Use in depth cognitive testing to develop optimal medication self-report item sets, 2) Conduct psychometric testing, and 3) Conduct construct validity testing. The approach is innovative because rigorous cognitive testing has not yet been used to optimize the quality of adherence self-report. The proposed research is significant because valid, standardized items for the self-report of medication adherence, across all of a patient's medications, are critically needed for both clinical care and research. Although this proposal focuses on persons with HIV disease, because our testing will focus both on ART and on other non-ART medications, our findings should be generalizable to all persons with chronic conditions. PUBLIC HEALTH RELEVANCE: Achieving optimal health outcomes for persons with HIV requires that they adhere not only with antiretroviral medications, but also with medications for non-infectious conditions such as diabetes. We propose to develop and validate a small set of self-report items that can be used to identify persons with adherence problems so that they can be efficiently targeted for interventions. Although this proposal focuses on persons with HIV disease, the items we develop should be usable for adherence assessment for medications for persons with any chronic condition.