ADHERENCE IN RECENTLY SOBER HIV+ WOMEN:ECOSYSTEMIC(RMI)

描述（由申请人提供）：本申请提出了一个结构性的生态系统干预HIV药物依从性（SETA）在最近清醒的妇女。最近清醒在本提案中被定义为DSM IV在过去一年内但不是在过去60天内的药物依赖或滥用。为期4个月的干预措施以妇女、她们的家庭和她们的社会网络为目标，将其作为基础设施的基石，以支持艾滋病毒医疗依从性、减少艾滋病毒传播风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感染艾滋病毒的妇女与其保健系统之间的建设性关系。为支持这一目标，应注意以下方面：1)减少前吸毒者从其家庭所经历的消极影响；2)建立牢固的界限，将妇女与经常引发吸毒复发的吸毒家庭和朋友分开；3)对于有孩子的妇女，恢复妇女作为父母的作用，提高其养育能力，并加强其在养育职能方面得到的支持；建立多个相互关联的亲社会支持系统，以加强康复进程并保持健康行为，包括艾滋病毒传播风险和艾滋病毒治疗依从性。这项研究将招募196名妇女，并将她们随机分配到SETA干预组，或者一个旨在与SETA相匹配的艾滋病毒健康组。女性每隔2个月接受一次评估，为期12个月。HIV医疗依从性通过自我报告、MEMS CAP和病毒载量来衡量。假设SETA干预相对于艾滋病毒健康对照组可以改善艾滋病毒医疗依从性。假设的中介因素有：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中介将使用层次线性模型进行测试。这将是该研究者获得的第一个奖项。

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.