ADHERENCE IN RECENTLY SOBER HIV+ WOMEN: ECOSYSTEMIC TX

描述(由申请人提供)：这项申请建议对最近戒酒的妇女进行结构性生态系统干预(SETA)，以改善艾滋病毒的医疗依从性。最近清醒在这项提案中被定义为在过去一年内而不是在最近60天内对DSM IV药物依赖或滥用。为期4个月的干预以妇女、她们的家庭和她们的社交网络为目标，作为基础设施的基石，以支持艾滋病毒的医疗坚持、减少艾滋病毒传播危险行为和预防药物滥用复发。这一基础设施的一个重要组成部分是艾滋病毒感染妇女与其保健系统之间的建设性关系。支持这一点的是1)减少前吸毒者来自其家人的负面影响，2)建立明确的界限，将妇女与经常引发吸毒复发的家庭和朋友分开，3)对于有孩子的妇女，恢复妇女=S作为父母的角色，改善她的育儿能力，并加强她在养育职能方面得到的支持，4)发展整合良好、多种联系的亲社会支持系统，以加强康复过程，并保持健康的行为，包括艾滋病毒传播风险和艾滋病毒的医疗坚持。这项研究将招募196名女性，并随机将她们分配到SETA干预组，或旨在与SETA相匹配的艾滋病毒健康小组。妇女每隔2个月进行一次评估，为期12个月。HIV医疗依从性是通过自我报告、MEMS CAP和病毒载量来衡量的。SETA干预假设是为了提高相对于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。干预的效果和假设的调解人将使用分层线性建模进行检验。这将是这位调查员的第一个奖项。

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.