Influence of Food Insecurity on Adherence

描述（由申请人提供）：本研究提案要求3年的支持，以开展发展干预研究，设计和现场测试基于理论的干预措施，以解决食品不安全问题，并改善艾滋病毒感染者的抗逆转录病毒治疗（ART）依从性。粮食不安全在美国市中心的艾滋病毒感染者中普遍存在，多达43%的人没有足够的食物并经历间歇性饥饿。粮食不安全已证明与抗逆转录病毒治疗依从性直接相关，包括预测不依从性高于抑郁、社会支持和酒精使用等其他因素。鉴于相互竞争的生存需要以及酗酒、成瘾和营养不良对健康造成的严重综合后果，与药物滥用有关的粮食不安全问题尤其严重。在压力与应对资源保护理论的指导下，我们将开展3个阶段的干预发展研究：(1)对服用抗逆转录病毒药物、使用药物和经历粮食不安全的艾滋病毒感染者进行初步访谈和焦点小组。根据从快速形成性研究中获得的信息，第一阶段的研究将用于制定基于理论的干预措施，以解决获取食物和维持抗逆转录病毒治疗依从性的问题；(2)对正在接受抗逆转录病毒治疗、使用药物和经历粮食不安全的艾滋病毒阳性男性和女性进行小样本调查，检验新开发的粮食不安全和依从性干预措施的可行性。第二阶段还将最后确定和试点测试用于数据收集的所有评估工具和协议；(3)进行随机现场试验，确定粮食不安全和抗逆转录病毒治疗依从性干预的潜在效果。现场测试的参与者将被随机分配接受新开发的干预措施或时间匹配的注意力比较条件。在6个月的随访期后，我们将测试各组在抗逆转录病毒治疗依从性、食物获取、营养和应对资源结果方面的差异。干预发展将包括试点测试日常饮食，情绪和物质使用行为监测互动短信调查。我们还将研究干预对资源保护理论衍生的中介理论结构的影响。我们的发展研究也将探讨在面对面的干预会议中进行干预的可行性和可接受性。因此，拟议的干预研究将制定新的策略，用于在具有多种相互竞争需求的不利条件下服用抗逆转录病毒药物的艾滋病毒感染者。

DESCRIPTION (provided by applicant): This research proposal requests 3 years of support to conduct developmental intervention studies to design and field test a theory-based intervention to address food insecurity and improve antiretroviral therapy (ART) adherence among men and women living with HIV infection. Food insecurity is prevalent among people living with HIV in US inner-cities, with as many as 43% not having sufficient food and experiencing intermittent hunger. Food insecurity has demonstrated direct associations with ART adherence including predicting non-adherence over and above other factors including depression, social support, and alcohol use. Food insecurity is particularly problematic in relation to substance abuse given competing survival needs and the dire combined health consequences of alcoholism, addiction and malnutrition. Guided by the Conservation of Resources Theory of Stress and Coping, we will conduct 3 stages of intervention development research: (1) initial interviews and focus groups with people living with HIV who take ART, use substances, and experience food insecurity. Based on information gained from rapid formative studies, this first stage of research will be used to develop a theory-based intervention to address accessing food and sustaining ART adherence; (2) Test the feasibility of the newly developed food insecurity and adherence intervention with a small sample of HIV positive men and women who are taking ART, use substances, and experience food insecurity. Stage 2 will also finalize and pilot test all assessment instruments and protocols for data collection; and (3) Conduct a randomized field test to determine the potential efficacy of the food insecurity and ART adherence intervention. Participants in the field test will be randomly assigned to either receive the newly developed intervention or a time matched attention comparison condition. Following a 6- month follow-up period, we will test for differences between groups on ART adherence, food access, nutrition, and coping resource outcomes. The intervention development will include pilot testing daily food, mood, and substance use behaviors monitored by interactive text-message surveys. We will also examine the intervention effects on mediating theoretical constructs derived by Conservation of Resources Theory. Our developmental research will also examine the feasibility and acceptability of conducting the intervention in face-to-face intervention sessions. The proposed intervention research will therefore develop new strategies for use with people living with HIV who are taking ART under adverse conditions with multiple competing needs.