Informal Caregiving & Medical Adherence Among HIV+ IDUs

描述(由申请者提供)：贫困的市中心非裔美国人社区的药物滥用和艾滋病毒/艾滋病的比率高得不成比例。在那些艾滋病毒血清阳性的人中，非裔美国人和药物滥用者往往没有达到最佳的医疗服务使用和服药依从性，疾病进展更快。HAART的最佳使用需要在一段时间内几乎完全坚持，这就需要具有长期可持续性的行为干预。社会支持一直被发现与HIV用药依从性、卫生服务利用和其他与健康相关的行为有关。有关非正式护理的文献表明，慢性病患者的主要支持关系可能是医疗依从性干预的重要目标。这项拟议研究的目标是研究注射吸毒者(IDU)之间的主要支持关系在促进和阻碍HIV医疗服务利用和HAART遵守方面的作用，并基于这些发现开发、试点并使之成为文化上适当的遵医促进干预措施。这项拟议的研究建立在我们的研究团队关于注射吸毒者非正式艾滋病毒护理、社会网络、艾滋病毒依从性以及弱势人群中成功的预防干预研究和医疗依从性的广泛先前研究的基础上。对慢性病患者的大部分护理都是由家人和朋友非正式地提供的。在慢性病患者中，随着非正式护理的实施，获得工具性援助与更好的医疗依从性有关。与收入较高的白人相比，低收入的非裔美国人提供更多的非正式(艾滋病毒)照顾，并报告较低的与照顾相关的痛苦，但更有可能停止非正式照顾。研究结果表明，非裔美国人吸毒者的主要支持关系不仅是重要的支持来源，而且可能影响他们的健康相关行为。本研究以社会影响和网络资源交换理论为基础，运用创新的社会网络方法考察社会环境对依附行为的影响。随着抗病毒疗法在未来几年迅速成为发展中国家艾滋病毒方案的一部分，网络方法可能是在低资源环境下有效、低成本、以社区为基础的依从性促进的可行选择。请拨四年经费，对500名前艾滋病毒/艾滋病吸毒者及其最多两名与艾滋病毒有关的主要支持者(n=400)的社区样本进行四次半年度评估。评估将包括病毒载量和CD4计数，对于子集，将包括MEMS上限、计算机化临床和医疗服务使用记录，以验证自我报告。研究结果将有助于为行为依从性干预确定合适的目标和方法。

DESCRIPTION (provided by applicant): Disadvantaged inner-city African American communities have disproportionately high rates of substance abuse and HIV/AIDS. Among those HIV seropositive, African Americans and substance abusers tend to have suboptimal medical service use and medication adherence and more rapid illness progression. Optimal use of HAART requires near complete adherence for an indefinite period of time, necessitating behavioral interventions with long-term sustainability. Social support has consistently been found to be associated with HIV medication adherence, health service utilization, and other health-related behaviors. Literature on informal caregiving suggests that main supportive ties of the chronically ill may be important targets of medical adherence intervention. The goals of the proposed study are to examine the role of main supportive ties among injection drug users (IDUs) in promoting and impeding HIV medical service utilization and HAART adherence, and to develop, pilot, and manualize a culturally appropriate adherence promotion intervention based on these findings. The proposed study builds on our research team's extensive prior research on IDUs' informal HIV caregiving, social networks, HIV adherence, and successful prevention intervention research, medical adherence in vulnerable populations. Most care for the chronically ill is provided informally by family and friends. Among the chronically ill, receipt of instrumental assistance, as informal care is operationalized, is associated with better medical adherence. Low income African Americans compared to higher income whites provide more informal (HIV) caregiving and report lower caregiving-related distress, yet are more likely to cease informal caregiving. Findings have demonstrated that African American IDUs' main supportive ties are not only important sources of support but may influence their health-related behaviors. The proposed study is based on theories of social influence and network resource exchange and utilizes an innovative social network approach to the examination of social environmental influences on adherence behaviors. As antiviral therapies rapidly begin to become part of HIV programs in developing countries over the next few years, network approaches may be viable options for effective, low cost, community-based adherence promotion in low resource settings. Four years funding is requested for four semi-annual assessments of a community sample of 500 former IDUs living with HIV/AIDS and up to two of their main HIV-related supporters (n=400). Assessments will include viral load and CD4 count, and for a subset, MEMS caps, computerized clinical, and medical service use records for validation of self-reports. Study findings will contribute to the identification of appropriate targets and approaches for the behavioral adherence intervention.