CBSM INTERVENTION IN WOMEN WITH HIV/AIDS

这是一个为期5年的项目，旨在测试为期12周的小组认知 行为压力管理（CBSM）干预-每月 维护计划-健康行为、情绪和心理 适应、生活质量和身体健康状况及预后 210名感染艾滋病毒的妇女正在使用联合抗逆转录病毒药物 治疗（CART）（范围从无症状，有症状无艾滋病， 出现艾滋病症状）。这项研究是一项2x 4随机实验， 实验条件设计（CBSM + CART与常规治疗 [CART]作为组因子和时间点（治疗前、治疗后）之间的 治疗、6个月和12个月随访）作为组内因素。 初步证据来自对一组有症状的前 艾滋病HIV阳性非洲裔美国妇女（n=24）提示 情感困扰干预的缓冲效应 （抑郁和逃避思想）和CD 4下降， 随着时间的推移控制条件。这与我们此前 发表了关于艾滋病前无症状和有症状的艾滋病毒阳性男同性恋者的论文 我们证明了CBSM缓冲了心理和免疫 对艾滋病毒血清阳性诊断（或处理症状）的影响， 减少社会孤立，改善适应性应对策略。在 我们建议扩大试点调查的拟议项目， * 将妇女包括在艾滋病毒的各个方面。在 此外，由于艾滋病毒/艾滋病流行病的特点不断变化， (i.e.,成功引进蛋白酶抑制剂和抗逆转录病毒药物 我们还打算关注（a）CBSM是否 可以实施干预措施以增强健康行为（药物治疗 坚持，减少物质使用，减少不安全的性行为）， 生活质量的其他方面（职业、教育 独立/赋权、社会/社区参与），（B）这些 行为、心理和免疫影响， 病毒载量和减少疾病进展，以及（c）如何有效 CBSM将在艾滋病毒/艾滋病连续体沿着的各个阶段的妇女中使用 包括那些当时已经发展成艾滋病的人 干预。

This is a 5-year project to test the efficacy of a 12-week group cognitive behavioral stress management (CBSM) intervention--and a monthly maintenance program--on health behaviors, mood and psychological adjustment, quality of life and physical health status and prognosis in 210 women with HIV infection who are using combination antiretroviral therapy (CART) (and who range from asymptomatic, symptomatic without AIDS, to symptomatic with AIDS). The study is a 2x4 randomized experimental design with experimental conditions (CBSM plus CART versus usual care [CART] as a between group factor and time point (pre-treatment, post- treatment, 6- and 12-month follow up) as a within group factor. Preliminary evidence from pilot testing with a group of symptomatic pre- AIDS HIV positive African American women (n=24) is suggestive of a buffering effect for the intervention for both affective distress (depression and avoidant thoughts) and for CD4 decline observed in the control condition over time. This is consistent with our previously published papers on asymptomatic and symptomatic pre-AIDS HIV+ gay men where we demonstrated that CBSM buffered the psychological and immune impact on an HIV-seropositive diagnosis (or dealing with symptoms), decreased social isolation, and improved adaptive coping strategies. In the proposed project we proposed to extend our pilot investigation with women to include women spanning the full range of the HIV continuum. In addition, because of the changing characteristics of the HIV/AIDS epidemic (i.e., successful introduction of protease inhibitors and antiretroviral combination therapies) we intend to focus also on (a) whether a CBSM intervention can be implemented to enhance health behaviors (medication adherence, reduced substance use, and reduced unsafe sexual behaviors) and other aspects of quality of life (vocational, educational independence/empowerment, social/community involvement), (b) whether these behavioral, psychological and immune effects are accompanied by low levels of viral load and decreased disease progression, and (c) how effective CBSM would be in women at various stages along the HIV/AIDS continuum including those who have already progressed to full-blown AIDS at the time of intervention.