Intervention Targeting Substance Using Older Adults with HIV

描述（由申请人提供）：50岁以上的艾滋病毒阳性成年人的数量正在稳步增加，疾病预防控制中心估计，到2015年，几乎一半的艾滋病毒/艾滋病感染者将年满50岁。尽管发病率不断上升，但没有公布针对老年艾滋病毒感染者酗酒和/或吸毒或坚持服药的干预措施。该提案旨在测试针对艾滋病毒阳性成年人的经证实的干预措施的适应性，并对其进行调整，以满足有酒精和/或药物依赖的艾滋病毒阳性老年人的独特需求。具体而言，该项目将进行一项随机对照试验，以评估12次干预的有效性，精神自我图式疗法（3S+），与12次基于教育的注意力控制条件（艾德）相比，在改善艾滋病毒健康结果，减少酒精和/或物质依赖的艾滋病毒+老年人中的酒精/药物使用。这一项目将是第一个扩大经证明的干预措施的项目，专门满足这一危急人群的独特需要。建议的治疗，3S+疗法，是一个完全手动化和证明有效的干预，结合了非宗派佛教原则的认知疗法的元素。我们建议将3S+扩展到以前未检测过的人群：酒精或药物依赖的HIV+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阳性老年人（50岁及以上，n = 240），他们报告艾滋病毒自我护理欠佳（对艾滋病毒药物治疗方案的依从性低于90%）。治疗条件将接受12个疗程的3S+治疗，针对老年艾滋病毒阳性成年人的特定需求，而教育（比较）条件将接受12个疗程的教育，围绕艾滋病毒药物依从性，药物和酒精使用以及性风险承担。利用药物和酒精使用（自我报告和生物学措施）和HIV健康（自我报告的药物依从性，HIV自我护理和HIV健康的生物学措施）的几项措施，本研究将在随机化后4个月，8个月和12个月测试干预的有效性，以确定干预的即时和长期影响。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阳性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，如药物依从性，艾滋病毒自我护理和性风险行为;和3）这种治疗可以很容易地传播和整合到现有的艾滋病毒诊所和其他社区组织提供的方案，解决艾滋病毒+老年人的药物和/或酒精问题的需要。总的来说，这种干预措施有助于减少药物和酒精滥用，并提高艾滋病毒阳性老年人的健康和福祉。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心影响，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抗药性具有潜在影响。

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.