ADHERENCE IN RECENTLY SOBER HIV+ WOMEN: ECOSYSTEMIC TX

描述（由申请人提供）：本申请提出了一种结构性生态系统干预措施，用于最近清醒的女性的艾滋病毒医疗依从性（SETA）。最近清醒的定义是在过去一年内，但不是在过去60天内DSM IV药物依赖或滥用。为期4个月的干预措施针对妇女、她们的家庭及其社交网络，将其作为基础设施的组成部分，以支持艾滋病毒医疗依从性、减少艾滋病毒传播风险行为和预防药物滥用复发。这一基础设施的一个重要部分是感染艾滋病毒的妇女与其保健系统之间的建设性关系。这一点得到了支持，注意：1）减少前吸毒者从其家人那里感受到的消极情绪，2）建立严格的界限，将妇女与吸毒的家人和朋友分开，因为他们经常会引发吸毒的复发，3）对于有子女的妇女，恢复妇女作为父母的角色，提高其养育子女的能力，4）发展良好的综合性、多重连接的亲社会支持系统，以加强康复过程，保持健康的行为，包括艾滋病毒传播风险和艾滋病毒医疗依从性。该研究将招募196名妇女，并将她们随机分配到SETA干预组或旨在与SETA相匹配的HIV健康组。每隔2个月对妇女进行一次评估，为期12个月。艾滋病毒的医疗依从性是通过自我报告，MEMS CAP和病毒载量来衡量的。SETA干预被假设为改善相对于HIV健康对照组的HIV医疗依从性。假设的中介因素是：家庭功能，社会支持，医患互动，健康信念和药物滥用复发。将使用分层线性模型测试干预和假设介质的效果。这将是该研究员的第一个奖项。

DESCRIPTION (provided by applicant): This application proposes a structural ecosystemic intervention for HIV medical adherence (SETA) in recently sober women. Recently sober is defined in this proposal as DSM IV drug dependence or abuse within the last year and but not in the last 60 days. The 4-month intervention targets women, their families, and their social networks as the building blocks for the infrastructure to support HIV medical adherence, reduction in HIV transmission risk behaviors and drug abuse relapse prevention. An important part of this infrastructure is a constructive relationship between the HIV infected women and their health care system. This is buttressed with attention to 1) reducing the negativity former drug users experience from their families, 2) establishing firm boundaries to separate the women from drug using family and friends who can frequently trigger relapse to drug use, 3) for women with children, restoring the women=s role as a parent, improving her parenting abilities, and enhancing the support she receives for parenting functions and 4) developing well integrated, multiply connected pro-social support systems to reinforce the recovery process and maintain healthy behaviors including HIV transmission risk and HIV medical adherence. The study will enroll 196 women and randomly assign them to either the SETA intervention, or an HIV health group designed to match SETA for attention. Women are assessed at 2-month intervals for a period of 12 months. HIV medical adherence is measured by self-report, MEMS CAP, and viral load. The SETA intervention is hypothesized to improve HIV medical adherence relative to the HIV health control group. The hypothesized mediating factors are: family functioning, social support, patient-doctor interactions, health beliefs, and drug abuse relapse. The effects of the intervention and the hypothesized mediators will be tested using Hierarchical Linear Modeling. This will be the first award for this investigator.