Daily Psychosocial Determinants of ART Adherence in Substance-Using Black Men

描述（由申请人提供）：有一个迫切需要了解的心理和情境因素，影响坚持高活性抗逆转录病毒治疗（ART）之间的艾滋病毒+黑人男性与男性发生性关系（BMSM）在美国，特别是那些谁从事物质使用。这项研究的目的是使用交互式语音应答（IVR）技术，每天两次的电话日记，以探讨日常情境因素如何影响ART依从性，并制定一个每日主动计划（DPP）干预措施，该干预措施专为这一人群而设计，迄今为止，这还不是ART依从性干预措施的目标。药物使用是BMSM依从性的重要障碍。研究表明，要充分了解物质使用对MSM的福祉和健康行为的影响，研究必须检查物质使用行为，因为它发生在日常，情境水平。这项拟议中的研究将探讨物质使用的日常波动如何影响， 和压力的经历和支持（特别是接受/归属感和拒绝/歧视归因于污名化的身份，包括种族，性取向，艾滋病毒状态的经验）影响艾滋病毒+ BMSM坚持抗逆转录病毒治疗。具体而言，它将收集纵向数据，使用3周的电话日记，样本为居住在纽约市的90名18-30岁的HIV+ BMSM。通过评估参与者的物质使用，影响和压力体验以及每天两次电话日记（一个早上和一个晚上的日记评估）和MEMS帽的ART依从性，该研究可以确定关键变量的变化如何影响依从性。在收集和分析纵向数据（将提供有关情境-行为联系的信息）后，将对10名主要遵守者、10名不一致遵守者和10名较差遵守者进行深入访谈，重点关注日常主动规划。然后，定量和定性数据将用于制定一个简短的，个性化的DPP干预措施，以提高使用物质的HIV+ BMSM之间的依从性。 公共卫生相关性：艾滋病毒是美国黑人男性的公共卫生危机，特别是纽约市的黑人男性。特别是使用艾滋病毒阳性物质的男男性行为者（MSM）在坚持高效抗逆转录病毒治疗（ART）方面遇到很大困难，这种治疗可以改善健康状况并降低将艾滋病毒传播给性伴侣的可能性。因此，迫切需要确定如何通过增加依从性的促进者和机会以及减少依从性的障碍来提高使用艾滋病毒+物质的黑人男男性行为者对抗逆转录病毒疗法的依从性。

DESCRIPTION (provided by applicant): There is an urgent need to understand the psychological and situational factors that influence adherence to highly active antiretroviral therapy (ART) among HIV+ Black men who have sex with men (BMSM) in the United States, notably those who engage in substance use. The objectives of the proposed study are to use interactive voice response (IVR) technology with twice daily phone diaries to explore how daily situational factors influence ART adherence and to develop a daily proactive planning (DPP) intervention that is tailored for use within this population, which has not, to date, been the targt of ART adherence interventions. Substance use is an important barrier to adherence among BMSM. It also occurs with greater frequency in MSM than in other groups in the U.S. Research suggests that to fully understand the effects of substance use on the well-being and health behaviors of MSM, studies must examine substance use behavior as it occurs at the daily, situational level. The proposed study will explore how daily fluctuations in substance use, affect, and stressful experiences and support (particularly experiences of acceptance/belonging and rejection/discrimination attributed to stigmatized identities including race, sexual orientation, ad HIV status) influence adherence to ART among HIV+ BMSM. Specifically, it will collect longitudinal data using a 3-week phone diary with a sample of 90 HIV+ BMSM aged 18-30 residing in New York City. By assessing participants on substance use, affect, and stressful experiences and support with twice-a-day phone diaries (one morning and one evening diary assessment) and on ART adherence with MEMS caps, the study can determine how changes in key variables influence adherence. Following the collection and analysis of longitudinal data, which will provide information on situation-behavior links, in-depth interviews focused on daily proactive planning will be conducted with a sub-sample of 10 master adherers, 10 inconsistent adherers, and 10 poor adherers. The quantitative and qualitative data will then be used to develop a brief, personally-tailored DPP intervention to improve adherence among substance-using HIV+ BMSM. PUBLIC HEALTH RELEVANCE: HIV is a public health crisis among Black men in the United States, notably those in New York City. Substance-using HIV+ men who have sex with men (MSM) in particular experience great difficulties in adhering to highly active antiretroviral theray (ART), treatment that can improve health and decrease likelihood of HIV transmission to sex partners. There is an urgent need, therefore, to determine ways of boosting ART adherence in HIV+ substance-using Black MSM, both by increasing facilitators of and opportunities for adherence and by reducing barriers to adherence.