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

描述(由申请人提供)：迫切需要了解影响在美国进行男男性行为(BMSM)的艾滋病毒黑人男子，特别是那些从事药物使用的人接受高效抗逆转录病毒疗法(ART)的心理和环境因素。拟议研究的目标是使用交互式语音应答(IVR)技术，每天两次电话日记，以探索日常情景因素如何影响ART坚持，并开发为这一人群量身定做的每日主动计划(DPP)干预措施，这到目前为止还不是ART坚持干预的目标。物质使用是BMSM坚持使用的一个重要障碍。研究表明，为了充分了解物质使用对MSM的幸福感和健康行为的影响，研究必须检查物质使用行为发生在日常情景水平上。这项拟议的研究将探索物质使用的日常波动如何影响 而紧张的经历和支持(特别是由于种族、性取向和艾滋病毒状况等污名化身份而导致的接受/归属感和拒绝/歧视的经历)影响艾滋病毒BMSM对抗逆转录病毒治疗的坚持。具体地说，它将使用为期3周的电话日记收集纵向数据，样本为90名居住在纽约市的18-30岁的艾滋病毒BMSM。通过每天两次的电话日记(早上和晚上的日记评估)对参与者的药物使用、情感和压力体验和支持进行评估，以及对MEMS帽的艺术依从性进行评估，研究可以确定关键变量的变化如何影响坚持。在收集和分析了将提供情况-行为联系信息的纵向数据之后，将对10名主要拥护者、10名不一致的拥护者和10名较差的拥护者进行深入访谈，重点放在日常主动规划上。然后，定量和定性数据将被用于开发简短的、个人量身定制的DPP干预措施，以提高使用药物的艾滋病毒BMSM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.