Decision Making and HIV Risk: New Approaches to neuroAIDS Research in Drug Users

 描述：吸食可卡因等非法兴奋剂上瘾的人在艾滋病毒的持续传播中发挥着重要作用，因为性行为风险很高，而且在已经感染的人中，对抗逆转录病毒治疗的坚持很差。神经艾滋病领域提供了令人信服的证据，表明艾滋病毒感染者和/或吸毒者更有可能经历与艾滋病毒危险行为有关的决策缺陷。然而，病例对照设计和基于实验室的决策措施在预测“现实世界”中的艾滋病毒危险行为方面一直受到限制。这个艾文奖的目的是促进我们对吸毒成瘾和艾滋病毒感染影响与艾滋病毒危险行为相关的决策过程的认知机制的理解。具体地说，这项建议解决了该领域的以下限制：(1)将成瘾建模为一种静态状况，而不是一种慢性、复发性障碍，研究使用了严格的合格条件 最大限度地减少对人群的概括性和没有充分考虑药物使用的可变性和波动的分析；(2)受控实验室环境中旨在优化绩效的认知评估；以及(3)对难以接触到的人群的便利抽样的依赖。拟议的Avenir项目将：使用受访者驱动的采样来吸引来自社区的不同类型的可卡因使用者，包括艾滋病毒阳性和艾滋病毒阴性的可卡因使用者；在一年多的时间里对神经行为功能进行每三个月一次的实验室评估，以捕捉药物使用、决策和艾滋病毒风险行为的自然波动；以及使用移动健康(MHealth)技术在自然环境中实时评估认知功能和风险行为。在形成工作的初始阶段，包括与目标人群的焦点小组，我们将适应三个广泛使用的决策任务，并开发一款适用于移动设备的应用程序。然后，我们将对200名参与者进行筛选，并将其纳入神经艾滋病队列。在为期3至6个月的随访期间，队列参与者将使用智能手机记录日常药物使用和艾滋病毒风险行为，并完成对决策、药物状态(例如，渴望、醉酒)和背景(例如，环境、社交情况)的生态瞬时评估。这个Avenir项目建立在我之前对决策和艾滋病毒风险的研究的基础上，整合了多学科技术，以促进我们对吸毒者与艾滋病毒相关的决策的理解。通过使用创新的方法来改善

 DESCRIPTION: Individuals addicted to illicit stimulants like cocaine play an important role in the continued transmission of HIV due to high rates of sexual risk behavior and, among those already infected, poor adherence to antiretroviral therapy. The field of neuroAIDS has provided convincing evidence that persons with HIV infection and/or drug addiction are more likely to experience deficits in decision making that are potentially relevant to HIV risk behavior. However, case-control designs and laboratory-based measures of decision making have been limited in predicting HIV risk behaviors in the "real world." The goal of this Avenir Award is to advance our understanding of the cognitive mechanisms through which drug addiction and HIV infection impact decision- making processes relevant to HIV risk behavior. Specifically, this proposal addresses the following limitations of the field: (1) modeling addiction as a static condition rather than a chronic, relapsing disorder, with studies utilizing strict eligibility that minimize generalizability to the population and analyses that do not adequately account for variability and fluctuations in drug use; (2) cognitive assessments in controlled laboratory settings intended to optimize performance; and (3) reliance on convenience sampling for a hard-to-reach population. The proposed Avenir project will: use respondent driven sampling to engage a heterogeneous cohort of cocaine users, both HIV-positive and HIV-negative, from the community; conduct trimonthly laboratory-based assessments of neurobehavioral functioning over 1 year to capture natural fluctuations in drug use, decision making, and HIV risk behavior; and use mobile health (mHealth) technology to assess cognitive functioning and risk behaviors in real-time in natural settings. During an initial period of formative work, including focus group with the target population, we will adapt three widely used decision making tasks and develop an app for mobile devices. We will then screen and enroll 200 participants into the neuroAIDS cohort. Between the 3- and 6- month follow-ups, cohort participants will use a smartphone to record daily drug use and HIV risk behavior and complete ecological momentary assessments of decision making, drug state (e.g., craving, intoxication) and context (e.g., setting, social situation). This Avenir project builds logically from my previous research on decision making and HIV risk, integrating multi-disciplinary techniques to advance our understanding of HIV-related decision making in drug users. Through the use of innovative approaches to improve the