Community-based Self-management of HIV and Chronic Disease

描述（由申请人提供）：越来越多的美国人感染艾滋病毒/艾滋病，年龄在50岁或以上。大多数艾滋病毒阳性老年人必须控制多种慢性健康状况，这增加了自我管理健康的挑战。然而，解决这个问题的工作很少。试点研究表明，这一人群希望在艾滋病毒管理和依从性、慢性病管理和生活质量方面获得帮助。先前的研究也表明，电话咨询是可接受的，可行的，有效地改善老年艾滋病毒感染者的应对。因此，我们正在寻求测试针对艾滋病治疗依从性和慢性疾病自我管理的个性化电话咨询干预的有效性。电话形式有可能增加孤立或健康状况不佳的老年人获得自我管理支助服务的机会。主要目标是从社区艾滋病服务组织（ASOs）招募的450名年龄在50岁以上、患有艾滋病毒/艾滋病和其他慢性疾病的人进行随机对照试验。我们将评估10次个性化电话咨询干预的有效性，与10次注意力匹配的教学电话组比较组和信息匹配的书籍对照组进行比较。主要结局指标是基线、6个月、9个月和12个月随访时的HIV治疗依从性和与健康相关的生活质量。次要目的是评估组间在以下方面的差异：(a)总体慢性病治疗依从性；(b)解决问题的能力、自我效能和改变的准备；(c)感知压力和抑郁。制定个体化干预措施，以提高50岁及以上感染艾滋病毒/艾滋病和其他共病慢性疾病的人的艾滋病毒特异性和一般慢性疾病自我管理技能和动机，将有助于解决这一人群的广泛需求。我们提出的干预和招聘计划利用了现有社区组织的优势，从长远来看，可能有潜力帮助这些组织建立为感染艾滋病毒的老年人提供服务的能力。建议的干预模式和形式也可以推广到其他人群的多种慢性疾病。

DESCRIPTION (provided by applicant): A growing number of Americans living with HIV/ AIDS are aged 50 or older. The majority of HIV+ older persons must manage multiple chronic health conditions, which increases the challenge of self-managing their health. However, little work has addressed this issue. Pilot research showed this population desires assistance with HIV management and adherence, chronic disease management, and quality of life. Prior research has also shown telephone counseling to be acceptable, feasible, and efficacious in improving coping among older HIV+ persons. We are therefore seeking to test the efficacy of an individualized telephone counseling intervention focused on HIV treatment adherence and chronic disease self- management. A telephone format has potential to increase access to self-management support services among older adults who may be isolated or in poor health. Primary aims are to conduct a randomized controlled trial with 450 persons recruited from community-based AIDS Service Organizations (ASOs) who are aged 50+ years and living with HIV/AIDS and other chronic conditions. We will evaluate the efficacy of an experimental 10-session individually-tailored telephone counseling intervention, as compared to a 10- session attention-matched didactic telephone group comparison arm, and an information-matched book only control arm. Primary outcome measures are HIV treatment adherence and health-related quality of life at baseline, 6, 9, and 12-month follow-ups. Secondary aims are to evaluate between group differences in: (a) overall chronic disease treatment adherence; (b) problem-solving skills, self-efficacy, and readiness to change; and (c) perceived stress and depression. Development of an individualized intervention to enhance HIV-specific and general chronic illness self-management skills and motivation among persons aged 50 and older living with HIV/AIDS and other comorbid chronic conditions will help to address the broad needs of this population. Our proposed intervention and recruitment plan capitalizes on the strengths of existing community-based organizations, and in the long-term may have the potential to help build their capacity to serve older persons with HIV. The proposed intervention model and format could also be generalizable to other populations of persons with multiple chronic conditions..