Mediators of the Relationship Between Depression and HIV Medication Adherence

抑郁症与艾滋病毒药物依从性之间关系的中介因素

• 批准号: 8408869
• 负责人: Jessica F Magidson
• 金额: $ 5.3万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8408869
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Adherence; Affect; Alcohol or Other Drugs use; Attitude; Behavioral; CD4 Lymphocyte Count; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinic; Clinical; Data; Development; District of Columbia; Drug resistance; Effectiveness; Environment; Environmental Risk Factor; Epidemic; Future; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Highly Active Antiretroviral Therapy; Individual; Infection; Intervention; Life; Link; Low income; Measures; Mediating; Mediator of activation protein; Mental Depression; Meta-Analysis; Minority; Modeling; Outcome; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Positive Reinforcements; Prevention; Psychological reinforcement; Psychosocial Factor; Public Health; Recruitment Activity; Reporting; Research; Research Personnel; Resistance; Risk; Role; Sampling; Self Efficacy; Social support; Stigmata; Testing; Training; Treatment Efficacy; Valverde; Viral; Viral Load result; Work; base; career; depressive symptoms; design; health disparity; high risk; improved; medication compliance; resistant strain; social stigma; theories; therapy adherence; transmission process; treatment adherence; urban area

DESCRIPTION (provided by applicant): Poor adherence to highly active antiretroviral therapy (HAART) is a significant clinical issue in the treatment and prevention of HIV, as extremely high levels of HAART adherence are necessary to maintain viral suppression. Recent evidence suggests only 19% of individuals on HAART nationwide show optimal adherence and achieve full viral suppression. Efforts to better understand and improve HAART adherence are crucial to managing the HIV/AIDS epidemic. A group that evidences a disproportionate burden of new HIV infection is low-income minority substance users living in urban areas. In D.C. specifically, where the highest rate of new HIV/AIDS cases in the U.S. are reported each year, the most notable increase in new infection has been among low-income, minority substance users. In this group, one of the most significant and prevalent patient-level barriers to adherence is depressive symptoms. Depressive symptoms, even at subclinical levels, predict nonadherence above and beyond other relevant psychosocial factors, including current substance use. Despite the focus on depressive symptoms as a reliable and powerful predictor of HAART nonadherence among substance users with HIV, few studies have sought to test potential mechanisms underlying this relationship, which is an important step to advance our understanding of how depression affects adherence to inform intervention efforts in this group. Using reinforcement-based theory, we focus on two key shared behavioral/environmental factors related to both depression and substance use that include: (1) reductions in goal-directed activity level and (2) reductions in positive reinforcement in one's environment. Extensive evidence suggests the relevance of these factors to HAART adherence; however, they have not been tested as potential mediators of the relationship between depressive symptoms and HAART adherence. Thus, the aim of the proposal is to test the mediating roles of goal-directed activity level and positive reinforcement in this relationship in a sample of low-income HIV positive substance users. We will use a repeated measures design assessing self-report and clinician rated measures of depressive symptoms, substance use, goal-directed activity level, positive reinforcement, and HAART adherence, as well as clinical indicators (Viral Load, CD4 count) over a 3-month period. The sample will include 125 HIV positive substance users recruited from a large HIV clinic in Washington, D.C. Results have important implications as they would provide the first test of potential mechanisms that may account for the relationship between depression and HAART adherence among low-income, minority substance users, a group at extremely high-risk for poor HIV outcomes. As Kazdin (2007) noted, it is crucial to identify mediators in order to maximize parsimony and optimize efficacy of interventions. Current findings have clear implications for increasing effectiveness and parsimony of integrated interventions to target depression and HAART adherence, as well as important implications for prevention, as better understanding and improving adherence may reduce the risk of transmission in this high-risk group. PUBLIC HEALTH RELEVANCE: Efforts to better understand and improve adherence to highly active antiretroviral therapy (HAART) among low- income, minority substance users living with HIV is crucial to managing the HIV/AIDS epidemic. One reliable and powerful predictor of nonadherence in this population is depression, yet to date no studies have tested how depression impacts adherence. The goal of the current proposal is to test potential mechanisms of the relationship between depression and HAART nonadherence among low-income HIV positive substance users, which has clear implications for increasing effectiveness and parsimony of existing prevention and treatment interventions.

描述（由申请人提供）：对高效抗逆转录病毒治疗（HAART）的依从性差是治疗和预防HIV的一个重要临床问题，因为极高水平的HAART依从性是维持病毒抑制所必需的。最近的证据表明，在全国范围内，只有19%的HAART患者表现出最佳的依从性，并实现了完全的病毒抑制。努力更好地理解和提高HAART依从性对于管理艾滋病毒/艾滋病流行至关重要。生活在城市地区的低收入少数群体药物使用者是新感染艾滋病毒负担不成比例的一个群体。特别是在华盛顿特区，那里每年报告的艾滋病毒/艾滋病新发病例率最高，新感染病例增加最明显的是低收入的少数群体药物使用者。在这一组中，最重要和最普遍的患者层面的依从性障碍之一是抑郁症状。抑郁症状，即使在亚临床水平，预测不遵守以上和其他相关的心理社会因素，包括目前的物质使用。尽管关注抑郁症状是HIV药物使用者HAART不依从性的可靠和有力的预测因素，但很少有研究试图测试这种关系的潜在机制，这是促进我们了解抑郁症如何影响依从性的重要一步，以告知这一群体的干预工作。使用基于认知的理论，我们专注于与抑郁症和物质使用相关的两个关键的共享行为/环境因素，包括：（1）目标导向活动水平的降低和（2）环境中正强化的减少。大量证据表明这些因素与HAART依从性相关;然而，它们尚未被测试为抑郁症状与HAART依从性之间关系的潜在介质。因此，该建议的目的是测试中介作用的目标导向的活动水平和积极的强化，在这种关系中的低收入艾滋病毒阳性物质使用者的样本。我们将使用重复测量设计，评估3个月内的抑郁症状、物质使用、目标导向活动水平、正强化和HAART依从性以及临床指标（病毒载量、CD 4计数）的自我报告和临床医生评定指标。该样本将包括从华盛顿，华盛顿特区的一家大型艾滋病诊所招募的125名艾滋病阳性药物使用者。结果具有重要意义，因为它们将首次测试可能解释低收入少数药物使用者（艾滋病不良结局的极高风险群体）中抑郁症与HAART依从性之间关系的潜在机制。正如Kazdin（2007年）所指出的，确定调解人至关重要，以便最大限度地节约和优化干预措施的效力。目前的研究结果对提高针对抑郁症和HAART依从性的综合干预措施的有效性和简约性具有明确的意义，对预防也具有重要意义，因为更好地理解和提高依从性可能会降低这一高危人群的传播风险。 公共卫生相关性：在感染艾滋病毒的低收入、少数群体药物使用者中，努力更好地了解和加强对高效抗逆转录病毒疗法的坚持，对于管理艾滋病毒/艾滋病流行至关重要。抑郁症是这一人群中不依从的一个可靠而有力的预测因素，但迄今为止还没有研究测试抑郁症如何影响依从性。本提案的目标是测试低收入HIV阳性药物使用者中抑郁症和HAART不依从性之间关系的潜在机制，这对提高现有预防和治疗干预措施的有效性和简约性具有明确的意义。