Motivating HIV+ Women: Risk Reduction and ART Adherence

描述(申请人提供)：妇女是艾滋病患者中增长最快的群体。它们通常是在疾病后期被诊断出来的，那时抗逆转录病毒治疗(ART)是强有力的指示。虽然ART方案在减少循环中的HIV病毒数量和增加CD4淋巴细胞计数方面有效，但它是复杂的，并且有许多副作用。需要近乎完美的坚持才能获得和保持效果，但由于方案的复杂性和副作用，很难实现这一点，特别是对于可能是艾滋病毒阳性伴侣和儿童的照顾者的妇女。随着接受抗逆转录病毒治疗的妇女开始感觉好起来，并恢复正常的活动，包括性行为，她们应该坚持抗逆转录病毒治疗和减少风险行为(RRB)。对抗逆转录病毒治疗依从性差的报告很常见，与RRB有关的报告正在出现。这项研究项目的长期目标是开发护理干预措施，以促进HIV+妇女同时遵守ART和RRB。这项随机对照行为试验的主要目标是测试针对HIV+妇女的群体动机干预对坚持抗逆转录病毒疗法和RRB的效果。次要目标是考察自我效能、结果预期和个人目标对坚持抗逆转录病毒疗法和RRB的中介作用。创新动机小组(MG)干预以动机访谈(MI)为核心。它包括8个90分钟的疗程，间隔2周，由一名护士领导，旨在告知和激励女性坚持ART并始终如一地使用RRB。使用MI技术，护士将促进与ART和/或RRB坚持相关的小组讨论。将培养自我效能感、积极的结果预期和有效的个人目标。干预将与由护士健康教育者领导的健康促进计划组成的8次注意力等量控制条件进行比较，所有参与者将在5个时间点使用音频计算机化自我访谈(ACASI)进行评估-基线、立即以及干预后3、6和9个月。RRB遵守情况将通过自我报告进行衡量。对ART的遵守程度将通过自我报告、eDEM上限和多组分遵守指数来衡量。病毒载量和CD4计数将在每个评估点通过图表审查获得。重复测量的方差分析将被用来检验基本假设，即MG条件下的参与者与对照组相比，对ART和RRB的依从率更高。回归分析将被用来检验调解人的效果。

DESCRIPTION (provided by applicant): Women comprise the fastest growing group of persons with AIDS. They are often diagnosed later in the disease, when antiretroviral therapy (ART) is strongly indicated. Though effective in reducing the amount of circulating HIV virus and increasing the CD4 lymphocyte count, ART regimens are complex and have numerous side effects. Near perfect adherence is required to obtain and maintain the effects, but because of regimen complexities and side effects it is difficult to achieve, particularly for women who may be caretakers for HIV+ partners and children. As women on ART begin to feel better, and resume normal activities, including sexual activities, they are expected to adhere to ART and risk reduction behaviors (RRB). Reports of poor adherence to ART are common and those related to RRB are emerging. The long-term goal of this research project is to develop nursing interventions to promote adherence to both ART and RRB in HIV+ women. The primary objective of this randomized controlled behavioral trial is to test the effect of a group motivational intervention for HIV+ women on adherence to ART and RRB. The secondary objectives are to examine the mediator effects of self-efficacy, outcome expectancy, and personal goals on adherence to ART and RRB. The innovative Motivational Group (MG) intervention has motivational interviewing (MI) as the central component. It consists of 8 90-minute sessions, 2 weeks apart, led by a nurse, and is designed to inform and motivate women to adhere to ART and use RRB consistently. Using MI techniques the nurse will facilitate the group discussion relevant to ART and/or RRB adherence. Self-efficacy, positive outcome expectancy, and effective personal goals will be fostered. The intervention will be compared to an 8-session attention equivalent control condition consisting of a health promotion program led by a nurse health educator All participants wilt be assessed at five time points--baseline, immediately and 3, 6, and 9 months after the intervention using an audio computerized self-interview (ACASI). RRB adherence will be measured by self-report. Adherence to ART will be measured by self-report, eDems caps, and a Multi Component Adherence Index. Viral load and CD4 counts will be obtained by chart review at each assessment point. Repeated measures analysis of variance will be used to test the primary hypotheses that participants in the MG condition will have higher rates of adherence to ART and RRB compared to controls. Regression analyses will be used to test the effects of the mediators.