A Network Analytic Model of Adherence and Abstinence

描述（由申请人提供）：健康行为是健康的唯一最大决定因素。我们希望人们按照处方服药，遵循健康的饮食，获得充足的睡眠，避免有害物质和成瘾。这些行为可能被认为是二元行为——坚持和禁欲——个人可能每天都在做，也可能不做。然而，药物使用治疗或戒断的临床试验使用了广泛不同的效果衡量标准。对于这些不同的测量结果，没有明显的生物学或行为学解释。此外，坚持和节制的措施往往不能解释健康行为模式的丰富变化。这些坚持或戒断的模式可能会进一步影响个人的预后。这一建议提供了一种新的方法来衡量依从性和戒断性，使用了网络分析的概念。伽马指数衡量的是服用剂量（或未服用的物质）之间的联系，它在一个创新的代数模型中解释了一个人的坚持或戒断模式。该指数可用于模拟依从性和戒断，以检查其对临床相关生物学结果的影响。对于完全不遵守（或不禁欲），Gamma值为0，对于完全遵守（或完全禁欲），Gamma值为1。我们建议分析来自四个领域完成的临床试验的一系列数据集(1)艾滋病毒/艾滋病患者对高效抗逆转录病毒治疗（HAART）的依从性；(2)阿片类药物依赖者对丁丙诺啡治疗的依从性；(3)戒烟试验中的戒烟；(4)在酒精使用障碍受试者的试验中戒酒或减少饮酒。在抗病毒药物依从性的试验中，我们将研究其相关性

DESCRIPTION (provided by applicant): Health behavior is the single greatest determinant of health. We want people to take their medication as prescribed, follow healthful diets, get adequate sleep, and avoid harmful substances and addictions. These actions may be thought of as binary behaviors-adherence and abstinence-that individuals may engage in-or not-on a daily basis. Yet, clinical trials of substance use treatment or abstinence use widely disparate measures of effect. There is no obvious biological or behavioral explanation for these disparate measurements. Further, measures of adherence and abstinence often fail to account for the rich variation in the pattern of the health behavior. These patterns of adherence or abstinence may further contribute to the individual's prognosis. This proposal offers a novel method to measure adherence and abstinence, using concepts adapted from network analysis. The gamma index, which measures the connectedness of doses taken (or substances not taken), accounts for the pattern of an individual's adherence, or abstinence, in an innovative algebraic model. This index can be used to model adherence and abstinence to examine their effect on clinically relevant biologic outcomes. Gamma is bounded at a value of 0 for perfect non-adherence (or non-abstinence), and 1 for perfect adherence (or perfect abstinence). We propose to analyze a series of datasets from completed clinical trials in four domains (1) adherence to Highly Active Antiretroviral Therapy (HAART) in subjects with HIV/AIDS; (2) adherence to buprenorphine treatment in subjects with opioid dependence; (3) abstinence from tobacco in trials of smoking cessation; and (4) abstinence or reduction in drinking in trials of subjects with alcohol use disorders. In trials of antiviral adherence, we will examine associations between the index and changes in viral load. In trials of tobacco, alcohol and drug treatment, we will examine associations between the index and long-term abstinence rates. The Specific Aims of this project are to (1) Assess the ability of the gamma index to improve the explanatory power of adherence on changes in viral load in trials of antiviral therapy in individuals infected with HIV, and (2) Assess the ability of the gamma index to explain differences in cessation endpoints in trials of subjects with substance use disorders, such as alcohol abuse, drug use, and smoking. Daily records of adherence (or substance use) are needed for this modeling, which makes these studies, which employ ecological momentary assessment (EMA) methods, timeline follow-back techniques, or electronic pill cap data, ideal. The outstanding interdisciplinary team for this project includes renowned experts in adherence, graph theory and network analysis, the treatment of HIV, and use of licit and illicit substances. The gamma index offers to provide new insights into underlying patterns of health behavior, their relationship to clinical outcomes, a means of quantifying these patterns, and the possibility of novel real-time interventions to promote healthy behaviors.