Relationship Factors and HIV Treatment Adherence

描述（由申请人提供）：处于初级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益处。然而，在最近的一份报告中，在一个大的不同样本的成年艾滋病毒感染者中坚持抗逆转录病毒治疗（ART），我们在两个独立的样本中发现了一个违反直觉的联系，在一个主要的关系和更差的坚持药物治疗之间。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。本研究的目的是通过定性和定量的方法，调查与ART依从性相关的关系因素。本研究将分3个阶段进行。根据招募的可行性和旧金山弗朗西斯科地区HIV流行病学，我们将纳入HIV+血清一致性和血清不一致性男性夫妇。第一阶段是对关系动态和与坚持有关的合作伙伴策略进行定性调查。第2阶段将制定一项针对药物依从性的伴侣支持措施，并将包括第1阶段提供的具体策略。第三阶段将是一项对300对夫妇的横断面研究，将（a）验证第二阶段中构建的伴侣支持的依从性特定测量;（B）测试个体变量之间相互关系的特定假设（例如，生活质量、心理健康、物质使用）和夫妻水平变量（例如，关系满意度、冲突、依从性（特定伴侣支持）以及ART依从性和临床变量。ART依从性将通过2项经验证的自我报告指标进行测量。将通过病毒载量和CD 4计数评估临床状态。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之间的依从性产生临床影响，并对理解社会控制在艾滋病毒治疗依从性中的作用产生理论影响。

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.