HIV Treatment adherence in older adults: Role of social support and incarceration

描述：到2030年，三分之一的美国监狱人口将超过50岁。与此同时，监狱中的艾滋病毒流行率是一般人群的四倍，老年人在这些高流行率中所占的比例越来越大。尽管如此，对于老年囚犯从可能容易获得和更容易维持艾滋病毒治疗的教养所释放后所面临的成功坚持艾滋病毒治疗的障碍和促进因素，人们知之甚少。这项拟议的研究旨在调查被监禁的老年人和艾滋病毒的相关因素如何影响50岁以上、在过去五年内从监狱或监狱获释的艾滋病毒感染者对艾滋病毒药物的依从性和心理健康。本研究的目的1是通过对30名艾滋病毒阳性且在过去5年内有监禁史的前囚犯（50岁以上）进行深入访谈，确定对有监禁史的艾滋病毒感染的老年人坚持抗逆转录病毒药物治疗的障碍和促进因素。这一目标将包括探索三组人的差异，根据他们从最后一次监禁释放以来的时间长短进行分层。目标2是描述这些老年前囚犯的释放后经历和社会支持网络（类型、规模及其社会角色）的特征，以及这些社会心理和经济经历以及社会网络特征对应对挑战和/或加剧坚持治疗和社会心理健康的障碍的影响。利用目标1和目标2的发现，目标3是通过焦点小组开发和评估以社区为基础的群体干预，以支持和增加有监禁史的老年艾滋病毒感染者对治疗的依从性。这项研究的影响在于，它有望提供出狱后经历的关键信息，这些信息可能是快速增长但在很大程度上被遗忘的有监禁史的老年艾滋病毒感染者亚群中成功坚持艾滋病毒治疗的障碍和促进者。

DESCRIPTION: By 2030, one-third of the US prison population will be over age 50. Meanwhile, the HIV prevalence rate in corrections is four times higher than in the general population and older adults are an increasing proportion of these higher rates. Nonetheless, little is known about the barriers and facilitators to successful HIV treatment adherence that older inmates confront after being released from correctional settings where HIV treatment may be readily available and more easily maintained. The proposed study is designed to examine how older adulthood, having been incarcerated, and the correlates of HIV affect adherence to HIV medication and the psychosocial well-being of people living with HIV who are over age 50 and have been released from prison or jail in the last five years. AIM 1 of the study is to identify barriers and facilitators to adherence to ARV specific to older adults with HIV infection who have a history of incarceration through in-depth interviews with 30 HIV-positive former inmates (over age 50) who have a history of incarcerations in the last 5 years. This aim will include exploring differences in three groups, stratified by length of time since their release from the last incarceration. AIM 2 is to characterize the post-release experiences and the social support networks (types, size, and their social roles) of these older former inmates and the influence of these psychosocial and economic experiences and social network characteristics on meeting the challenges and/or exacerbating the barriers to adherence to treatment and psychosocial well-being. Using findings from Aims 1 & 2, Aim 3 is to develop and evaluate through focus groups a community- based, group intervention to support and increase adherence to treatment among older adults with HIV with a history of incarceration. The impact of this study lies in its promise of providing critical information on post- release experiences which could be barriers and facilitators to successful HIV treatment adherence among a rapidly growing but largely forgotten subpopulation of older adults living with HIV with a history of incarceration.