Intervention Targeting Substance Using Older Adults with HIV

描述(由申请人提供)：50岁以上的艾滋病毒+成年人的数量正在稳步增加，美国疾病控制与预防中心估计，到2015年，几乎一半的艾滋病毒/艾滋病感染者将达到50岁或以上。尽管艾滋病毒携带率上升，但没有针对酒精和/或药物使用或老年艾滋病毒携带者服药依从性的公开干预措施。这项提议旨在测试针对HIV+成年人的成熟干预措施的适应性，并对其进行量身定制，以满足艾滋病毒+老年人酒精和/或药物依赖的独特需求。具体地说，该项目将进行一项随机对照试验，以评估12次干预--精神自我图式疗法(3S+)与12次基于教育的注意控制条件(ED)相比，在改善艾滋病毒健康结果、减少酒精和/或药物依赖艾滋病毒+老年人的酒精/药物使用方面的效果。该项目将是第一个扩展经过验证的干预措施，以满足这一关键人群的独特需求。建议的治疗方法，3S+疗法，是一种完全机械化的、被证明有效的干预方法，它将认知疗法的元素与非宗派佛教原则相结合。我们建议将3S+扩展到以前未经测试的人群：依赖酒精或药物的艾滋病毒+老年人。拟议的干预措施将针对纽约市有药物和/或酒精依赖的艾滋病毒+老年人(50岁及以上，n=240)，他们报告的艾滋病毒自我护理效果不佳(不到90%坚持他们的艾滋病毒药物治疗方案)。治疗条件组将接受12次针对艾滋病毒+老年人的特定需求的3S+治疗，而教育(比较)条件组将接受12次关于艾滋病毒药物依从性、药物和酒精使用以及性风险的教育。利用药物和酒精使用(自我报告和生物测量)和艾滋病毒健康(自我报告的用药依从性、艾滋病毒自我护理和艾滋病毒健康的生物测量)的几个指标，这项研究将在随机化后的4、8和12个月测试干预的效果，以确定干预的直接和长期影响。该项目的意义和影响有三个方面：1)将灵性融入成瘾治疗对艾滋病毒+成人和老年人显示出巨大的希望；2)除了针对成瘾，拟议的干预措施还解决了影响艾滋病毒健康的多种风险因素，如服药依从性、艾滋病毒自我护理和性危险行为；以及3)这种治疗可以很容易地传播并整合到现有的艾滋病毒诊所和其他社区组织中，这些组织提供解决艾滋病毒+有毒品和/或酒精问题的老年人的需求的计划。总的来说，这种干预措施可以帮助减少药物和酒精滥用，并增加艾滋病毒+老年人的艾滋病毒健康和福祉。如果有效，干预措施将有助于最大限度地减少与吸毒和酗酒有关的负面身体和心理影响，并改善艾滋病毒健康和自我护理，这对生存和健康以及减少艾滋病毒传播和艾滋病毒耐药性具有潜在影响。 公共卫生相关性：这项研究的结果将有助于改善对日益增长的人口的艾滋病毒治疗：依赖酒精和/或药物的老年艾滋病毒+成年人。这项研究的结果将为艾滋病毒的预防、干预和治疗提供参考，旨在减少酒精和药物的使用和滥用，并增加50岁及以上人群的艾滋病毒自我护理和整体健康和福祉。

DESCRIPTION (provided by applicant): The number of HIV+ adults over age 50 is increasing steadily, and the CDC has estimated that by 2015 almost half of those living with HIV/AIDS will be age 50 or older. In spite of these rising rates, there are no published interventions targeting alcohol and/or substance use or medication adherence among older adults with HIV. This proposal is designed to test an adaptation of a proven intervention for HIV+ adults and tailor it to meet the unique needs of HIV+ older adults with alcohol and/or drug dependence. Specifically, this project will conduct an RCT to evaluate the efficacy of a 12-session intervention, Spiritual Self-Schema Therapy (3S+), compared to a 12-session education-based attentional control condition (ED), in improving HIV health outcomes, and reducing alcohol/drug use among alcohol and/or substance dependent HIV+ older adults. This project would be the first to extend a proven intervention tailored to meet the unique needs of this critical population. The proposed treatment, 3S+ therapy, is a fully manuallized and proven effective intervention which combines elements of cognitive therapy with non-sectarian Buddhist principles. We propose to extend 3S+ to a previously untested population: alcohol or drug dependent HIV+ older adults. The proposed intervention will target HIV+ older adults (age 50 and older, n = 240) with drug and/or alcohol dependence in New York City who report suboptimal HIV self care (less than 90% adherence to their HIV medication regimens). The treatment condition will receive 12 sessions of 3S+ therapy tailored to the specific needs of older HIV+ adults, while the education (comparison) condition will receive 12 sessions of education surrounding HIV medication adherence, drug and alcohol use, and sexual risk-taking. Utilizing several measures of drug and alcohol use (both self reported and biological measures) and HIV health (self reported medication adherence, HIV self care, and biological measures of HIV health), this study will test the efficacy of the intervention at 4, 8, and 12 months post-randomization to determine both immediate and long-lasting effects of the intervention. The significance and impact of this project is threefold: 1) the integration of spirituality into addiction treatment has shown great promise for HIV+ adults and older adults, 2) in addition to targeting addiction, the proposed intervention addresses multiple risk factors that impact HIV health, such as medication adherence, HIV self care, and sexual risk behavior; and 3) this treatment can be readily disseminated and integrated into existing HIV clinics and other community-based organizations offering programs addressing the needs of HIV+ older adults with drug and/or alcohol problems. Broadly, this intervention could help to reduce drug and alcohol abuse and increase HIV health and well-being among HIV+ older adults. If effective, the intervention will help minimize the negative physical and psychological effects associated with drug and alcohol use and improve HIV health and self care, which has potential effects for survival and health as well as reducing HIV transmission and HIV drug resistance. PUBLIC HEALTH RELEVANCE: The findings of this study will contribute to improved HIV treatment of a growing population: older HIV+ adults who are dependent on alcohol and/or drugs. The findings of this study will inform HIV preventions, interventions, and treatments designed to decrease alcohol and drug use and abuse, and increase HIV self care and overall health and wellbeing among those aged 50 and older.