Motivating HIV+ Women: Risk Reduction and ART Adherence

描述（由申请人提供）：妇女是艾滋病患者中增长最快的群体。当强烈需要抗逆转录病毒治疗（ART）时，他们往往在疾病晚期才被诊断出来。尽管抗逆转录病毒疗法能有效地减少循环中的艾滋病毒数量和增加CD4淋巴细胞计数，但它的治疗方案很复杂，而且有许多副作用。为了获得和维持效果，需要近乎完美的依从性，但由于治疗方案的复杂性和副作用，这很难实现，特别是对于可能照顾艾滋病毒阳性伴侣和儿童的妇女。随着接受抗逆转录病毒治疗的妇女开始感觉好转，并恢复正常活动，包括性活动，她们应坚持抗逆转录病毒治疗和降低风险行为（RRB）。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。本研究项目的长期目标是制定护理干预措施，以促进艾滋病毒阳性妇女坚持抗逆转录病毒治疗和RRB治疗。这项随机对照行为试验的主要目的是测试艾滋病毒阳性妇女群体动机干预对ART和RRB依从性的影响。次要目的是检验自我效能、结果预期和个人目标对ART和RRB依从性的中介作用。创新动机团体干预以动机访谈（MI）为核心内容。它包括8次90分钟的会议，间隔2周，由一名护士领导，旨在告知和激励妇女坚持抗逆转录病毒治疗并始终如一地使用RRB。使用MI技术，护士将促进与ART和/或RRB依从性相关的小组讨论。自我效能、积极的结果预期和有效的个人目标将得到培养。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期注意力等效控制条件进行比较。所有参与者将在五个时间点进行评估——基线、立即和干预后3、6和9个月，使用音频计算机化自我访谈（ACASI）。RRB依从性将通过自我报告来衡量。ART的依从性将通过自我报告、edms上限和多组分依从性指数来衡量。病毒载量和CD4计数将在每个评估点通过图表审查获得。将使用重复测量方差分析来检验MG条件下的参与者与对照组相比具有更高的ART和RRB依从率的主要假设。回归分析将用于检验中介的效果。

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.