Changing ART Adherence Behavior

当按处方服用时，抗逆转录病毒疗法(ART)对艾滋病毒携带者的健康和福祉有巨大影响。然而，接受抗逆转录病毒治疗的艾滋病毒+患者必须严格遵守往往复杂和容易产生副作用的治疗方案，才能从这种疗法中受益，并避免感染可能传播给他人的艾滋病毒耐药株。虽然95%的抗逆转录病毒疗法依从性对病毒抑制至关重要，但在HIV+临床样本中，实际依从率为60%-70%或更低是常见的。尽管不是最理想的遵守 抗逆转录病毒疗法可能会对个人和公共健康造成极其严重的后果，但很少有以理论为基础、经过严格评估的干预措施被实施，并被发现在临床护理环境中有效。大多数现有的提高对抗逆转录病毒治疗依从性的方法都涉及劳动密集型、以个人为重点的干预措施，这些干预措施尚未证明有效，而且过于密集和昂贵，无法广泛应用。总体而言，艾滋病毒临床环境中抗逆转录病毒治疗依从性的护理标准是特别的和最低限度的。该提案涉及开发、试行、实施和严格评估 帮助HIV+患者坚持抗逆转录病毒治疗的方法。它使用坚持的信息-动机-行为技能(IMB)模型(J.Fisher，2000a；J.Fisher等人，2002a；W.Fisher等人，在出版社)来设计、实施和评估可在临床护理环境中广泛实施的个性化、交互式、成本效益高的计算机辅助ART坚持干预。该干预将使用激励性访谈技术(例如，Rollnick等人，2000)作为传递系统，用于向即将开始抗逆转录病毒疗法的HIV+患者和接受抗逆转录病毒疗法的患者传达个人定制的抗逆转录病毒治疗依从性相关信息、动机和行为技能(IMB)内容，以促进高水平的初始依从性，以提高依从性和促进 保持最佳的遵守水平。在18个月的随访间隔中，ART依从性干预将与适当的护理标准对照组在评估结果研究中ART依从性的多个指标方面进行比较。护理标准对照组还将允许我们研究ART依从性的自然历史及其纵向动态，作为诸如主观和客观健康变化、药物滥用状况、疾病阶段、接受ART的时间长短等因素的函数。这本身也代表了对艺术坚持研究的重要贡献。

When taken as prescribed, antiretroviral therapy (ART) has dramatic effects on the health and well-being of HIV+ individuals. HIV+ persons on ART, however, must adhere rigorously to an often complex and side-effect prone therapeutic regimen to benefit from this therapy, and to avoid contracting treatment resistant strains of HIV that can potentially be transmitted to others. While 95% adherence to ART is critical for viral suppression, actual adherence rates of 60-70% and lower are common in HIV+ clinical samples. Although suboptimal adherence to ART may have extremely serious individual and public health consequences, few theory-based, rigorously evaluated interventions to increase adherence to ART have been implemented and found to be effective in clinical care settings. Most extant approaches to enhancing adherence to ART involve labor-intensive, individually focused interventions, which have yet to demonstrate efficacy, and which are too intensive and too expensive to deploy widely. Overall, the standard-of-care for ART adherence in HIV clinical settings is ad hoc and minimal. This proposal involves the development, piloting, implementation, and rigorous evaluation of an innovative approach to assisting HIV+ individuals to adhere to ART. It uses the Information - Motivation - Behavioral Skills (IMB) model of adherence (J. Fisher, 2000a; J. Fisher et al., 2002a; W. Fisher et al., in press) to design, implement and evaluate an individualized, interactive, cost-effective, computer-assisted ART adherence intervention that can be widely implemented in clinical care settings. The intervention will use Motivational Interviewing techniques (e.g., Rollnick et al., 2000) as a delivery system for conveying individually tailored ART adherence-related information, motivation, and behavioral skills (IMB) content to HIV+ patients about to begin ART, to facilitate high levels of initial adherence, and to patients on ART, to enhance adherence and promote maintenance of optimal levels of adherence. The ART adherence intervention will be compared with an appropriate standard-of-care control group in terms of mutiple indicators of ART adherence in evaluation outcome research over an 18-month follow-up interval. The standard-of-care control group will also permit us to study the natural history of ART adherence and its longitudinal dynamics, as a function of factors such as changes in subjective and objective health, substance abuse status, disease stage, length of time on ART, and other factors. This, in its own right, also represents an important contribution to ART adherence research.