Adherence Intervention for HIV-infected Drug Users

对感染艾滋病毒的吸毒者的依从性干预

• 批准号: 9504400
• 负责人: Kasey R Claborn
• 金额: $ 18.8万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9504400
• 关键词: Address; Adherence; Adoption; Anti-Retroviral Agents; Area; Award; Behavior Therapy; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical; Cognitive Therapy; Collection; Communities; Comorbidity; Data; Data Analyses; Development; Diagnostic; Disease Progression; Drug Targeting; Drug resistance; Drug usage; Drug user; Effectiveness; Evaluation; Exhibits; Focus Groups; Goals; Group Interviews; Group Structure; HIV; Health; Health education; Hybrids; Illicit Drugs; Individual; Inferior; Intervention; Interview; Life; Link; Manuals; Measures; Mentors; Mentorship; Methods; Modification; Morbidity - disease rate; National Institute of Drug Abuse; Outcome; Participant; Patients; Pharmaceutical Preparations; Phase; Population; Process; Protocols documentation; Provider; Public Health; Qualitative Methods; Qualitative Research; Randomized Controlled Trials; Readiness; Recommendation; Recruitment Activity; Regimen; Reporting; Research; Research Methodology; Research Personnel; Research Training; Resistance development; Risk Behaviors; Science; Scientist; Social support; Standardization; Testing; Time; Training; Treatment Efficacy; Treatment outcome; Work; antiretroviral therapy; base; brief motivational intervention; career; contextual factors; drug development; evidence base; experience; field study; follow-up; high risk population; illicit drug use; implementation science; implementation trial; improved; individualized medicine; medication compliance; mortality; motivational enhancement therapy; pilot trial; preference; programs; public health relevance; skills; socioeconomics; therapy adherence; therapy development; transmission process; uptake

 DESCRIPTION (provided by applicant): This K23 research and training award advances the long-term goal of improving treatment outcomes and reducing transmission of HIV among HIV-infected drug users. The proposed training and research plans will enable the PI to develop the skills needed for an independent research career in the area of illicit drug use and HIV adherence intervention. The objective of this application is to develop skills in implementation science, behavioral intervention development and evaluation with drug using populations, and in-depth qualitative data analysis to accelerate refinement and effective implementation of interventions for HIV-infected drug users. Multiple comorbidities such as drug use and HIV act synergistically to produce poorer health outcomes and increase morbidity, mortality, and transmission of HIV. Consequently, effective and sustainable interventions adapted to drug users to improve antiretroviral medication adherence and reduce risk behaviors are urgently needed. Drug users present unique treatment challenges compared with other HIV-infected populations, including lower rates of adherence and inferior treatment outcomes. Additionally, interpersonal factors, including social support, negative patient-provider interactions, and socioeconomic challenges present significant barriers to adherence. Thus, the generalizability of current adherence interventions to drug users is limited, and there is a pressing need for efficacious interventions adapted to HIV-infected drug using populations. This application addresses this gap by being the first to adapt and test the acceptability and efficacy of a combined adherence and brief motivational intervention for HIV-infected drug users. Specifically, the intervention will augment the established Life Steps adherence intervention to include: (1) a tailored Life Steps module addressing the unique needs of illicit drug users, aimed at improving medication adherence; (2) a brief Motivational Interview to address drug use and other risk behaviors; and (3) two follow-up booster sessions. A three-phase, top-down research approach to adapt, refine, and pilot test the intervention will be conducted. Phase 1 will include focus groups with HIV-infected drug users currently prescribed antiretroviral medications and individual interviews with community-based clinicians. Phase 2 will include manual development, therapist training, a pilot trial, in-depth qualitative interviews, and further manual revisions. Phase 3 will include a small, 2-armed (intervention vs. health education control) randomized controlled trial with 60 HIV-infected drug users. Feasibility, acceptability, and preliminary indication of improvement in antiretroviral adherence and reduction in drug use will be examined at 1-, 3-, and 6-month follow-ups. To enable the PI to pursue this long-term research agenda, she will work with experienced mentors to build three areas of expertise: (1) proficiency in qualitative research methods and analysis; (2) skills in intervention development and evaluation with illicit drug using populations; (3) expertise in advanced longitudinal data analysis; and (4) implementation science. This K23 proposal addresses a key priority in HIV treatment science, and it will fully prepare the PI for an independent research career as an HIV intervention scientist.

 该K23研究和培训奖推进了改善治疗结果和减少艾滋病毒感染吸毒者中艾滋病毒传播的长期目标。拟议的培训和研究计划将使PI能够发展在非法药物使用和艾滋病毒依从性干预领域独立研究所需的技能。该应用程序的目标是培养实施科学、吸毒人群行为干预开发和评估以及深入定性数据分析方面的技能，以加速改进和有效实施针对艾滋病毒感染吸毒者的干预措施。多种合并症，如吸毒和艾滋病毒协同作用，产生更差的健康结果，增加发病率，死亡率和艾滋病毒的传播。因此，迫切需要针对吸毒者采取有效和可持续的干预措施，以提高抗逆转录病毒药物治疗的依从性，减少危险行为。与其他艾滋病毒感染人群相比，吸毒者在治疗方面面临独特的挑战，包括坚持率较低和治疗结果较差。此外，人际因素，包括社会支持，消极的患者-提供者互动和社会经济挑战，对依从性构成了重大障碍。因此，目前对吸毒者的依从性干预措施的普遍性有限，迫切需要适用于感染艾滋病毒的吸毒人群的有效干预措施。该应用程序解决了这一差距，是第一个适应和测试的可接受性和有效性相结合的坚持和简短的动机干预艾滋病毒感染的吸毒者。具体而言，干预措施将加强既定的生活步骤坚持干预措施，包括：（1）一个量身定制的生活步骤模块，解决非法药物使用者的独特需求，旨在提高药物依从性;（2）一个简短的动机访谈，以解决药物使用和其他风险行为;和（3）两个后续助推器会议。一个三阶段，自上而下的研究方法，以适应，完善和试点测试的干预将进行。第一阶段将包括与目前处方抗逆转录病毒药物的艾滋病毒感染吸毒者的重点小组，以及与社区临床医生的个别访谈。第二阶段将包括手册开发，治疗师培训，试点试验，深入的定性访谈，以及进一步的手册 修订。第3阶段将包括一项小型、2组（干预与健康教育对照）随机对照试验，纳入60名HIV感染的吸毒者。将在1个月、3个月和6个月随访时检查抗逆转录病毒治疗依从性改善和药物使用减少的可行性、可接受性和初步指征。为了使PI能够追求这一长期研究议程，她将与经验丰富的导师合作，建立三个专业领域：（1）精通定性研究方法和分析;（2）与非法药物使用人群进行干预开发和评估的技能;（3）高级纵向数据分析的专业知识;和（4）实施科学。该K23提案解决了HIV治疗科学的关键优先事项，它将为PI作为HIV干预科学家的独立研究生涯做好充分准备。