Relationship Factors and HIV Treatment Adherence

描述(由申请人提供)：处于主要关系中被认为会导致后勤和情感支持，从而提供促进健康的好处。然而，在最近一份关于在艾滋病病毒携带者的成人样本中坚持抗逆转录病毒治疗(ART)的报告中，我们在两个不同的样本中发现了一种违反直觉的关联，即处于主要关系中和对药物的依从性更差之间。这些发现提出了一个问题，即关系动态如何影响对艾滋病毒治疗的坚持。这项研究的目的是通过定性和定量的方法，调查与坚持ART有关的关系因素。建议的研究将分三个阶段进行。基于招募的可行性和旧金山地区艾滋病毒流行的流行病学，我们将包括HIV+血清一致和血清不一致的男性夫妇。第一阶段将对关系动态和与坚持相关的合作伙伴策略进行定性调查。第二阶段将开发一种针对服药依从性的伴侣支持措施，并将包括由第一阶段提供信息的具体策略。第三阶段将是一项针对300对夫妇的横断面研究，将(A)验证第二阶段构建的伴侣支持的依从性特定衡量标准；(B)测试个体变量(例如，生活质量、心理健康、药物使用)和情侣水平变量(例如，关系满意度、冲突、特定伴侣支持)、ART依从性和临床变量之间相互关系的特定假设。对抗逆转录病毒治疗的遵守程度将通过2项有效的自我报告衡量。临床状态将通过病毒载量和CD4计数进行评估。所有阶段都将以社会控制理论为指导，研究结果将对制定干预措施以提高夫妇间的依从性具有临床意义，并对理解社会控制在艾滋病毒治疗依从性中的作用具有理论意义。

DESCRIPTION (provided by applicant): Being in a primary relationship is believed to result in logistic and emotional support that provides health- promoting benefits. However, in a recent report of adherence to antiretroviral therapy (ART) among a large diverse sample of adults living with HIV, we detected a counterintuitive association in two separate samples between being in a primary relationship and worse adherence to medications. Such findings raise the question of how relationship dynamics impact adherence to HIV treatment. The purpose of the proposed study is to investigate, through qualitative and quantitative methods, the relationship factors that are associated with adherence to ART. The proposed study will be conducted in 3 phases. Based on recruitment feasibility and the epidemiology of the HIV epidemic in the San Francisco area, we will include HIV+ seroconcordant and serodiscordant male couples. Phase 1 will be a qualitative investigation of relationship dynamics and partner tactics related to adherence. Phase 2 will be the development of a medication adherence-specific measure of partner support, and will include specific tactics informed by Phase 1. Phase 3 will be a cross-sectional study of 300 couples which will (a) validate the adherence specific measure of partner support constructed in Phase II; and (b) test specific hypotheses of the inter-relationships among individual variables (e.g., quality of life, psychological well being, substance use) and couple-level variables (e.g., relationship satisfaction, conflict, adherence specific partner support), and ART adherence and clinical variables. Adherence to ART will be measured by 2 validated self-report measures. Clinical status will be assessed by viral load and CD4 count. All phases will be guided by social control theory and findings will have clinical implications for the development of interventions to improve adherence within couples and theoretical implications for understanding the role of social control in HIV treatment adherence.