Testing the Efficacy and Mechanisms of an Adapted Resilience Building Intervention in People Aging with HIV

项目总结/摘要 尽管有证据表明：1）老年艾滋病毒感染者（PLHIV）经历了很大的压力负担， 与无数更糟糕的结果相关，2）心理弹性可以缓冲压力的负面影响 在老年PLHIV中，3）老年PLHIV可能比血清阴性PLHIV具有更低水平的这种保护因子 然而，与其他同行相比，很少有工作审查加强老年艾滋病毒感染者复原力的战略。为配合 NIH和PAR-21-069的使命，这个R21建议，在初步研究的指导下， 行为干预发展和一个强大的研究团队将推动复原力科学的发展 干预措施包括：1）一个重要的未被充分研究的人群：深处的老年艾滋病毒感染者 2）理论驱动的恢复力框架：以压力的跨学科模型为指导 和应对，复原力的保护因素模型，以及扩展和构建模型，我们操作化 弹性是一个过程，在这个过程中，个体拥有一套可延展的弹性资源， 对压力的反应能够更好地避免长时间的（或任何）功能中断。我们将使用一个 在理论上基于这些模型的弹性课程，并利用我们的试点数据进行了优化; 3)疗效和机制的严格验证：我们将在以下方面测试干预疗效： 弹性资源和使用实时方法的瞬时压力响应（即，经验取样 方法[ESM]）。这项随机对照试验将100名年龄在50岁以上的老年艾滋病病毒感染者随机分为干预组和对照组。 注意力匹配控制条件。我们的综合治疗包括近端机械性措施， (i.e.,无害环境管理对复原力资源和压力反应和恢复的衡量），以及健康（即， 心理功能和艾滋病毒结果）的测量。我们的主要目标集中在干预效果： 弹性资源的使用，以及这种增加是否会改善情感压力反应， 3个月时的恢复（目标1）和远端健康结局（目标2）。我们的探索目标是 治疗反应的调节剂。调查结果将确定干预机制，并告知 制定有效和可扩展的干预措施，以建立老年艾滋病毒感染者和其他 不同的老年人群体。

PROJECT SUMMARY/ABSTRACT Despite evidence that: 1) older people living with HIV (PLHIV) experience a high burden of stress that is associated with myriad poorer outcomes, 2) psychological resilience may buffer the negative effects of stress in older PLHIV, and 3) older PLHIV may possess lower levels of this protective factor than seronegative counterparts, little work has examined strategies to bolster resilience in older PLHIV. In line with the mission of NIH and PAR-21-069, this R21 proposal, guided by preliminary studies, the Stage Model for Behavioral Intervention Development, and a strong research team, will advance the science on resilience interventions by including: 1) AN IMPORTANT UNDERSTUDIED POPULATION: older PLHIV in the Deep South; 2) A THEORY-DRIVEN RESILIENCE FRAMEWORK: Guided by The Transactional Model of Stress and Coping, the Protective Factor Model of Resilience, and the Broaden-and-Build Model, we operationalize resilience as a process whereby individuals with a set of malleable resilience resources for both appraising and responding to stress are better able to avoid prolonged (or any) disruptions in functioning. We will use a resilience curriculum that is theoretically grounded in these models and has been optimized with our pilot data; 3) RIGOROUS EXAMINATION OF EFFICACY AND MECHANISMS: We will test intervention efficacy on resilience resources and momentary stress responses using real-time methods (i.e., experience sampling method [ESM]). This RCT will randomize 100 older PLHIV aged 50+ to either an intervention condition or an attention-matched control condition. Our comprehensive battery will include proximal mechanistic measures, (i.e., ESM measurement of resilience resources and stress reactivity and recovery), and health (i.e., psychological functioning and HIV outcomes) measures. Our Primary Aims focus on intervention effects on: the use of resilience resources and whether such increases drive improved affective stress reactivity and recovery (Aim 1) and distal health outcomes at three months (Aim 2). Our exploratory aim will examine moderators of treatment response. Findings will identify intervention mechanisms and inform the development of potent and scalable interventions for building resilience in older PLHIV and other diverse populations of older adults.