CLINICAL AND PSYCHOSOCIAL INFLUENCES ON HIV THERAPY

描述（申请人的摘要）：新的和仍在发展的抗病毒药物 HIV药物已证明在降低病毒载量方面取得了早期成功， 在某些病人身上逆转了一个无法逆转的临床过程。的 这些药物的使用效果及其对人和 艾滋病的流行，将不仅取决于药理学和分子生物学 因素（例如，耐药性、长期副作用、耐药性） 而且还取决于经济、文化和社会因素（例如，访问和 可用性、合规性、风险行为的变化、风险 社交网络的配置，以及这些因素的演变）。 传统上，诊所无法评估后一种因素， 因为他们的结构不是进行家访，做外展，或评估， 患者的社会背景。在这项研究中，研究人员建议， 研究社会网络因素对自然历史的影响， 抗病毒药物的使用，以及这些药物对 个人健康和疾病传播的可能性。的 社会网络因素（风险配置，稳定性，结构， 组成、强度和密度）将同时考虑 与其他关键的流行病学，临床和心理学的作用， 因素将研究四组人：第I组（n=180）-- 经诊所确定正在接受抗病毒治疗的人 (HIV第二组（n=60）-在诊所查明的 可能适合但目前未接受抗病毒治疗 (HIV第三组（n=60）-在社区中确定为 艾滋病毒感染者，诊所可为他们提供服务，但他们不使用 未接受抗病毒治疗的患者;第IV组（n=60）-患者 在社区中确定谁有人口和行为 特征与第三组相似，但未感染 艾滋病。临床和实验室评估信息， 心理访谈和测试，以及实地外联评估， 包括使用人种学和社会网络分析 技术来定义社会环境，将被收集。每个人 每隔六个月接受一次面试，共四次面试。 收集的信息将用于评估社交网络的作用 在存在潜在混杂因素的情况下， 流行病学、临床和心理因素。因此，本研究将 提供有关各种因素的信息--都是在 而传统上诊所是不提供的--这会影响 抗病毒药物使用的自然史，并将作为基础， 全面评估有效性和设计潜力 干预措施。

DESCRIPTION (Applicant's Abstract): The new and still evolving antiviral agents for HIV have demonstrated early success in reducing viral load and reversing an inexorable clinical course in some patients. The use-effectiveness of these drugs, and their impact on persons and on the AIDS epidemic, will depend not only on pharmacologic and molecular biologic factors (e.g., drug tolerance, longer term side effects, drug resistance) but on economic, cultural, and social factors as well (e.g., access and availability, compliance, changes in risk behavior, changes in the risk configuration of social networks, and the evolution of these factors). Traditionally, clinics are not in a position to assess the latter factors, since they are not structured to make home visits, do outreach, or evaluate patients' social context. In this study, the investigators propose to examine the influence of social network factors on the natural history of antiviral drug use, and on the use-effectiveness of these agents on the health of individuals and on the probability of disease transmission. The role of social network factors (risk configuration, stability, structure, composition, the strength and density) will be considered simultaneously with the role of other critical epidemiological, clinical, and psychological factors. Four groups of persons will be studied: Group I (n=180) -- persons ascertained in the clinic who are placed on antiviral therapy (HIV+); Group II (n=60) -- persons ascertained in the clinic who are potentially eligible for, but are not currently receiving, antiviral therapy (HIV+); Group III (n=60) -- persons ascertained in the community who are infected with HIV, for whom the clinic is available, but who do not use the clinic and are not on antiviral therapy; Group IV (n=60)-- persons ascertained in the community who have demographic and behavioral characteristics similar to those in Group III, but who are not infected with HIV. Information from clinical and laboratory assessments, from psychological interviews and tests, and from field outreach assessment, which includes using both ethnographic and social network analysis techniques to define the social environment, will be collected. Each person will be interviewed at 6-month intervals, for a total of four interviews. The collected information will be used to assess the role of social networks on drug adherence in the presence of potentially confounding epidemiological, clinical, and psychological factors. The study will thus provide information about a variety of factors -- both measured in the clinic and traditionally not available to the clinic -- that can influence the natural history of antiviral drug use, and will serve as a basis for comprehensive assessment of effectiveness and for the design of potential interventions.