Predictors of ART Adherence for Behaviorally-Infected HIV+ African-American Males

行为感染 HIV 的非裔美国男性 ART 依从性的预测因素

• 批准号: 8466623
• 负责人: Israel Gross
• 金额: $ 2.89万
• 依托单位: LOYOLA UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-07 至 2014-09-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8466623
• 关键词: AIDS/HIV problem; Adherence; Adolescent; Adolescent Medicine Trials Network; Affect; African American; Age; Anti-Retroviral Agents; Antiretroviral resistance; Buffers; CD4 Positive T Lymphocytes; Centers for Disease Control and Prevention (U.S.); Classification; Data; Data Analyses; Disease; Disease Progression; Dose; Epidemic; Exhibits; Future; General Population; Goals; HIV; HIV Infections; Household; Individual; Intervention; Life; Life Expectancy; Literature; Male Adolescents; Medical; Mental Health; Minority Groups; Modeling; Morbidity - disease rate; Multivariate Analysis; Mutate; Outcome; Participant; Pathway interactions; Pharmaceutical Preparations; Physician-Patient Relations; Prevention program; Preventive Intervention; Production; Protocols documentation; Provider; Public Health; Quality of life; Regimen; Research; Research Training; Risk; Risk Factors; Self Efficacy; Social support; Substance abuse problem; Techniques; Translating; Trees; United States; Viral; Viral Load result; Virus; antiretroviral therapy; compliance behavior; depressive symptoms; effective therapy; high risk; innovation; intervention program; male; medication compliance; mortality; particle; patient population; psychosocial; response; standard of care; therapy adherence; transmission process; young adult

DESCRIPTION (provided by applicant): The HIV/AIDS epidemic has affected millions of individuals worldwide over the past 30 years. Although there is currently no cure for HIV/AIDS, significant pharmacological advances in the treatment of HIV/AIDS have been developed, which has greatly extended the life expectancy and quality of life for individuals living with the diseas. Specifically, since 1996 antiretroviral (ARV) medication has been the standard of care in the United States, reducing the production of HIV viral particles in the body, as well as restoring the host body's immunological functioning. However, in order for (ARV) medication to be effective, a nearly 100% medication dose adherence rate is required. Individuals infected with HIV/AIDS on ARV medication regimens who are not adherent pose a significant public health risk as they are (a) at greater risk for disease progression; (b) more likely to be resistant to ARV medication treatment in the future; and (c) are more likely to transmit the virus to the general public, as wel as transmit mutated strains of the disease, which have a poorer response to ARV treatment. Adolescents and individuals from racial/ethnic minority backgrounds have been documented to have poor ARV adherence. Although prior studies have identified psychiatric illness and substance abuse to be strong predictors of ARV adherence, there is little research that examines the predictors of adherence among young adult and adolescent African American males, a demographic group at great risk for both HIV infection and ARV non-adherence. Therefore the objectives of the current study are to (a) identify the strongest predictors of ART adherence among African American adolescent and young adult males (<24 years) behaviorally infected with HIV; (b) to create a classification tree analysis model of adherence that maximizes classification accuracy for adherence and non-adherence; and (c) to identify the protective and risk factors that can be incorporated into intervention and prevention programs that increase ARV adherence. For the purpose of this study, a subsample of 790 African American males (<24 years) behaviorally-infected with HIV, who participated in the Adolescent Trials Network for HIV/AIDS Interventions (ATN) 086 protocol in 2010-2011, will be investigated using an exploratory multivariate analysis technique known as Optimal Data Analysis (ODA). ODA will allow the identification of the strongest predictor of adherence among a plethora of demographic, psychosocial, and biomedical data without increasing error. In addition, a classification tree analysis model will be created highlighting the pathways to adherence and non-adherence among African American males behaviorally-infected with HIV. PUBLIC HEALTH RELEVANCE: This research will make a significant public health contribution by identifying the strongest predictors and the pathways of antiretroviral (ARV) medication adherence among African-American adolescents and young adults behaviorally-infected with HIV; a demographic group at high-risk for ARV medication non-adherence and disease progression. The potential protective and risk factors identified in this study can be translated into future intervention and prevention targets, thereby decreasing morbidity, mortality, and HIV transmission rates among this high-risk group. Primary medical providers will also be able to have a greater understanding of what factors will have the strongest impact on promoting ART adherence among their patient population.

描述（由申请人提供）：过去30年来，艾滋病毒/艾滋病流行病影响了全球数百万人。虽然目前没有治愈艾滋病毒/艾滋病的方法，但在治疗艾滋病毒/艾滋病方面已经取得了重大的药理学进展，这大大延长了患有这种疾病的人的预期寿命和生活质量。具体而言，自1996年以来，抗逆转录病毒（ARV）药物一直是美国的标准护理，减少了体内HIV病毒颗粒的产生，并恢复了体内HIV病毒颗粒的数量。 宿主的免疫功能然而，为了使抗逆转录病毒药物有效，需要接近100%的药物剂量依从率。感染艾滋病毒/艾滋病的人如果不坚持抗逆转录病毒药物治疗，会对公共卫生造成重大风险，因为他们（a）疾病进展的风险更大;（B）将来更有可能对抗逆转录病毒药物治疗产生抗药性;（c）更有可能将病毒传播给公众，以及传播对抗逆转录病毒药物治疗反应较差的突变株。青少年和来自种族/少数民族背景的个人已被记录为抗逆转录病毒药物依从性差。虽然以前的研究已经确定精神疾病和药物滥用是抗逆转录病毒治疗依从性的强有力的预测因子，但很少有研究探讨年轻成年人和青少年非裔美国男性依从性的预测因子，这是一个艾滋病毒感染和抗逆转录病毒治疗不依从性风险很大的人口群体。因此，本研究的目的是（a）确定非洲裔美国青少年和年轻成年男性中ART依从性的最强预测因素（B）创建依从性的分类树分析模型，其最大化依从性和非依从性的分类准确性;以及（c）确定可纳入干预和预防计划的保护性和风险因素，以提高抗逆转录病毒药物的依从性。为了这项研究的目的，790名非洲裔美国男性（<24岁）行为感染艾滋病毒，谁参加了青少年试验网络艾滋病毒/艾滋病干预措施（ATN）086协议在2010-2011年的子样本，将使用探索性多变量分析技术被称为最佳数据分析（ODA）进行调查。ODA将允许在不增加错误的情况下，在大量的人口统计学、心理社会学和生物医学数据中识别出最强的依从性预测因子。此外，还将建立一个分类树分析模型，突出显示行为上感染艾滋病毒的非洲裔美国男性的依从性和不依从性。 公共卫生相关性：这项研究将通过确定最强的预测因子和非洲裔美国青少年和年轻人行为感染艾滋病毒的抗逆转录病毒（ARV）药物依从性的途径，做出重大的公共卫生贡献; ARV药物不依从性和疾病进展的高风险人口群体。在这项研究中确定的潜在的保护和风险因素可以转化为未来的干预和预防目标，从而降低发病率，死亡率和艾滋病毒的传播率在这一高风险群体。初级医疗服务提供者也将能够更好地了解哪些因素对促进患者人群的抗逆转录病毒治疗依从性影响最大。