HIV/AIDs and Aging: A Cognitive Clinical Intervention

描述(由申请人提供)：这项R21提案涉及一项探索性研究，以进一步开发和评估认知干预--间隔检索(SR)的使用，以提高HIV+老年人的HIV治疗依从性。有一些证据表明，诸如执行功能障碍等认知缺陷的发生率在艾滋病毒+老年人中可能特别高。考虑到HAART方案的复杂性，通常在HIV+老年人中发现的认知缺陷使他们尤其面临不遵守治疗方案的风险。Neundorfer等人。(2002)发现，将药盒、核对表、日历等外部辅助手段与适当使用此类辅助手段的SR策略培训相结合，是使HIV+老年人达到并维持治疗目标的有效手段，包括坚持用药，尽管执行功能存在缺陷。Joltin、Camp和McMahon(在出版中)发现，通过电话提供SR显示出作为一种替代方法的前景，可以为有记忆缺陷的老年人提供SR培训。在拟议的探索性研究中，60名艾滋病毒+老年人将接受培训，结合使用外部艾滋病和SR策略学习，以提高他们对艾滋病毒治疗的依从性。这些参与者中，一半将接受面对面的SR培训，另一半通过电话接受SR培训。每周两次，每次30分钟，为期四周(共8次)。据推测，至少90%的参与者将能够学习适当的策略，使他们能够在这段时间内使用与治疗依从性相关的外部辅助手段。治疗方案的依从性评估将在参与者的初始筛查、基线以及培训后的3个月、6个月和9个月的间隔再次进行。如果遵从性下降，将提供助推SR会议。临床结果(病毒载量、CD4计数)将在训练前和最后一次测试后进行评估。该项目的主要目标如下：目标1：确定这种针对老年HIV感染者的SR干预是否可以导致他们使用外部辅助手段来坚持治疗方案的学习策略。目的2：确定这种SR干预是否可以通过电话有效地传递给H1V+的老年人。目标3：确定通过SR干预学会使用外部辅助是否与HIV+老年人的成功依从性结果有关。目的4：研究依从性结果与临床结果之间的关系，即病毒载量和CD4计数。

DESCRIPTION (provided by applicant): This R21 proposal involves an exploratory study to further develop and evaluate the use of a cognitive intervention, spaced retrieval (SR), to improve HIV therapy adherence in HIV+ older adults. There is some evidence that the incidence of cognitive deficits such as executive dysfunction may be especially high in HIV+ older adults. Given the complexity of HAART regimens, cognitive deficits typically found in HIV+ older adults place them especially at risk for non-adherence to treatment regimens. Neundorfer et al. (2002) found that a combination of external aids such as pill boxes, checklists, calendars, etc. and SR strategy training in the appropriate use of such aids was an effective means of enabling HIV+ older adults to reach and maintain therapeutic goals, including medication adherence, in spite of deficits in executive function. Joltin, Camp, and McMahon, (in press) found that delivering SR over the telephone shows promise as an alternative means of providing SR training to older adults with memory deficits. In the proposed exploratory study, 60 HIV+ older individuals will be trained using a combination of practice with external aids and SR strategy learning to improve their adherence to HIV therapy. Half of these participants will receive SR training in a face-to-face format, the other half over the telephone. Thirty-minute training sessions will be given twice a week for four weeks (8 sessions). It is hypothesized that at least 90% of the participants will be able to learn appropriate strategies enabling them to use external aids related to therapy adherence during this time frame. Assessments of adherence to therapy regimens will be conducted at initial screening of participants, at baseline, and again at 3-month, 6-month, and 9-month intervals after training. Booster SR sessions will be provided if adherence declines. Clinical outcomes (viral load, CD4 count) will be assessed before training and at final posttest. The primary objectives of the project are as follows: Objective 1: To determine if this SR intervention for older adults with HIV can result in their learning strategies related to using external aids for adherence to treatment regimens. Objective 2: To determine if this SR intervention can be delivered effectively over the telephone to H1V+ older adults. Objective 3: To determine if learning to use external aids with this SR intervention is related to successful adherence outcomes in HIV+ older adults. Objective 4: To examine the relationships between adherence outcomes and clinical outcomes, i.e., viral load and CD4 counts.