P1042S (VERSION 10) COGNITIVE, BEHAVIORAL AND PSYCHOSOCIAL CORRELATES OF MED

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。近年来，由于耐药性和治疗方案日益复杂，对感染艾滋病毒的儿童和青少年来说，坚持服药已成为一个关键问题。在抗逆转录病毒临床试验中，药物的不依从性使我们测量新药有效性的能力变得复杂，在儿童中观察到的较低的反应率与成人相比，部分原因是依从性的问题。药物依从性在青春期变得越来越成问题。围产期获得性艾滋病毒感染的青春期前和青少年人数不断增加，需要了解影响药物依从性的因素。需要制定有效的干预措施，以促进依从性，并将其纳入临床护理和研究。临床医生应该了解哪些因素会影响青少年在治疗开始前遵循复杂治疗方案的能力。主要研究目标是：1)评估年龄、认知、行为和社会心理、功能（包括语言、记忆、注意力和学术技能）与服药依从性的关系，通过自我报告和药片数量来衡量；2)评估年龄、认知、行为和社会心理功能与参与者服药责任程度的关系，通过照顾者和自我报告问卷来衡量。次要目标是：1)了解围产期获得性艾滋病毒感染儿童和青少年的认知、行为和社会心理功能特征；2)将认知、行为和社会心理功能与病毒学和疾病变量联系起来；3)评估参与者之间的互动？认知状态和药物治疗方案的复杂性预测依从性，通过自我报告和药片数量来衡量；4)评估基线认知、行为和社会心理变量预测后续时间点（入组后24周和48周）依从性的能力；5)评估自我报告与药物依从性指标的相关性；6)通过自我报告和药片数量来评估依从性随时间的稳定性；7)通过病毒载量、CDC疾病类别和CD4计数来衡量依从性与疾病严重程度的相关性，并评估依从性与疾病严重程度之间的相关性是否随时间稳定；8)开发一种预测模型，供临床医生使用，以识别更有可能在坚持抗逆转录病毒药物治疗方案方面出现问题的儿童和青少年。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. In recent years, medication adherence has become a critical issue for HIV-infected children and adolescents because of drug resistance and the increased complexity of treatment regimens. In antiretroviral clinical trials, non- adherence to medication complicates our ability to measure the effectiveness of new drugs, and the lower response rate observed in children compared to adults is partially explained by problems with adherence. Medication adherence becomes increasingly problematic during adolescence. The growing population of preteens and adolescents with perinatally acquired HIV infection demands an understanding of factors that influence medication adherence. Effective interventions that promote adherence and can be integrated into both clinical care and research need to be developed. Clinicians should understand what factors influence an adolescent's ability to follow a complex treatment regimen before therapy is initiated. Primary study objectives are: 1)To assess the relationship of age, cognitive, behavioral, and psychosocial, functioning (including language, memory, attention, and academic skills) with adherence to medication regimens, as measured by self-report and pill count.; 2) To assess the relationship of age, cognitive, behavioral, and psychosocial functioning with the degree of responsibility for taking medications placed on participants, as measured by caregiver and self-report questionnaires. Secondary objectives are: 1) To characterize cognitive, behavioral, and psychosocial functioning in children and adolescents with perinatally acquired HIV infection; 2) To correlate cognitive, behavioral, and psychosocial functioning with virologic and disease variables; 3) To assess interactions between participants? cognitive status and the complexity of their medication regimens in predicting adherence, as measured by self-report and pill count; 4) To assess the ability of baseline cognitive, behavioral, and psychosocial variables to predict adherence at a later time point (24 and 48 weeks following enrollment); 5) To assess the correlation of self-report and pill count measures of adherence; 6) To assess the stability of adherence over time as measured by self-report and pill counts; 7) To correlate measures of adherence with disease severity as measured by viral load, CDC disease category and CD4 counts, and to assess whether the association between adherence and disease severity is stable over time; and 8) To develop a predictive model that could be used by clinicians to identify children and adolescents who are more likely to have problems adhering to their antiretroviral medication regimens.