Relationship Factors and HIV Treatment Adherence

描述(由申请人提供)：此竞争续期申请建立在我们的项目“关系因素和艾滋病毒治疗坚持”(R01NR010187)的成功基础上，也被称为“Duo项目”。到目前为止，父母的赠款是成功的，这一过程和结果为这次续签申请的目标提供了信息。人们普遍认为，处于主要关系中会带来后勤和情感上的支持，从而带来促进健康的好处。然而，有证据表明，处于主要关系中可能会导致行为、情绪和冲突，这些可能会阻碍遵守规定的治疗方案。构建我们在社会控制理论中的工作，同时使用二元数据分析，并将夫妻作为分析单位，将使我们最大限度地理解夫妻互动如何影响坚持。到目前为止，我们的工作已经记录了伴侣动态和坚守之间的联系，并表明了随着时间的推移研究伴侣的重要性，以最好地了解关系因素和艺术坚守之间的动态相互作用。因此，我们现在建议通过混合定性、定量和随机对照试验(RCT)方法来扩展这项工作。目前的第三阶段研究是对男性夫妇的横断面调查，以测试个人层面变量(例如，对治疗效果、药物使用和坚持自我效能的信念)和夫妇层面变量(例如，关系满意度、冲突和特定于坚持的伴侣支持)以及药物依从性和临床变量之间的相互关系的假设。为了优化对依从性和社会关系文献的贡献，我们建议在6个月、12个月、18个月和24个月时对这些夫妇进行重复评估，以检验纵向假设。我们将有目的地挑选夫妇进行深入的定性访谈，以进一步阐明我们的发现并为干预措施提供信息。最后，我们将开发和试行以夫妻为基础的干预措施，Duo PACT(伙伴关系坚持承诺疗法)，包括32对夫妇(随机分为干预或仅评估对照)，以确定可行性、满意度，并为更大规模的干预试验的效果大小估计提供信息。三种经过充分验证的自我报告工具将衡量所有参与者对抗逆转录病毒治疗的遵守情况，我们还将使用MEMS CAPS监测和干预中的那些，为随后的更大规模的随机对照试验试行程序。临床状态将通过超敏感的病毒载量和CD4计数分析进行评估。意义重大。研究结果将对检测依从性问题以及进一步开发、评估和传播干预措施以改善夫妻关系中的依从性具有临床意义。研究结果还将对在非传统关系中和在不同血清状态配置中坚持使用艾滋病毒药物的背景下的社会控制功能具有理论意义。 与公共卫生相关：目前的提案解决了提高艾滋病毒抗逆转录病毒治疗依从性的挑战。研究结果将对检测和了解依从性问题以及进一步开发、评估和传播干预措施以提高夫妻关系中的依从性具有临床意义。研究结果还将对在人际关系中坚持艾滋病毒药物治疗的社会控制功能具有理论意义。

DESCRIPTION (provided by applicant): This competing renewal application builds upon the success of our project "Relationship Factors and HIV Treatment Adherence" (R01NR010187) also known as the "Duo Project". The parent grant has been successful thus far and the process and findings have informed the aims of this renewal application. Being in a primary relationship is generally accepted as resulting in logistic and emotional support that provides health- promoting benefits. However, there is evidence that being in a primary relationship may result in behaviors, emotions, and conflict that may hinder adherence to prescribed treatment regimens. Framing our work in Social Control Theory while using dyadic data analysis and maintaining the couple as the unit of analysis will maximize our understanding of how couple interactions affect adherence. Our work to date has documented associations between partner dynamics and adherence and has suggested the importance of studying couples over time to best understand the dynamic interplay of relationship factors and ART adherence. We are therefore now proposing to extend the work through mixed qualitative, quantitative and randomized controlled trial (RCT) methodologies. The current Phase 3 study is a cross-sectional investigation of male couples to test hypotheses of the interrelationships among individual-level variables (e.g., beliefs about treatment efficacy, substance use, and adherence self-efficacy) and couple-level variables (e.g., relationship satisfaction, conflict, and adherence-specific partner support), and medication adherence and clinical variables. To optimize the contribution to the adherence and social relationship literature, we propose to follow these couples with repeat assessments at 6, 12, 18 and 24 months to test longitudinal hypotheses. We will purposefully select couples for in-depth qualitative interviews to further contextualize our findings and to inform interventions. Finally, we will develop and pilot a couples-based intervention, Duo PACT (Partnership Adherence Commitment Therapy), with 32 couples (equally randomized to intervention or assessment only control) to determine feasibility, satisfaction, and to inform effect size estimates for a larger trial of the intervention. Three well- validated self-report instruments will measure adherence to ART in all participants, and we will also use MEMS caps monitoring with those in the intervention to pilot procedures for a subsequent larger RCT. Clinical status will be assessed by ultrasensitive viral load and CD4 count assays. Significance. Findings will have clinical implications for the detection of adherence problems and the further development, evaluation, and dissemination of interventions to improve adherence within the couple relationship. Study findings will also have theoretical implications for the function of social control in the context of adherence to HIV medications within non-traditional relationships and across different serostatus configurations. PUBLIC HEALTH RELEVANCE: The current proposal addresses the challenges of improving adherence to antiretroviral therapy for HIV. Findings will have clinical implications for the detecting and understanding adherence problems and the further development, evaluation, and dissemination of interventions to improve adherence within the couple relationship. Study findings will also have theoretical implications for the function of social control in the context of adherence to HIV medications within relationships.