Informal Caregiving & Medical Adherence Among HIV+ IDUs

描述（由申请人提供）：discriminalinner-city非洲裔美国人社区有不成比例的药物滥用和艾滋病毒/艾滋病的高利率。在艾滋病毒血清反应阳性的人中，非裔美国人和药物滥用者往往有次优的医疗服务使用和药物依从性，以及更快的疾病进展。HAART的最佳使用需要无限期地近乎完全坚持，需要长期可持续的行为干预。社会支持一直被发现与艾滋病毒药物治疗依从性，卫生服务利用和其他健康相关的行为。非正式治疗的文献表明，慢性病患者的主要支持关系可能是医疗依从性干预的重要目标。拟议的研究的目标是检查注射吸毒者（IDUs）之间的主要支持关系，促进和阻碍艾滋病毒医疗服务的利用和HAART依从性的作用，并制定，试点，并手动化的文化适当的依从性促进干预的基础上，这些研究结果。拟议的研究建立在我们的研究小组对注射吸毒者的非正式艾滋病毒传播，社交网络，艾滋病毒依从性，成功的预防干预研究，在弱势群体的医疗依从性的广泛研究。对慢性病患者的大部分照顾是由家人和朋友非正式地提供的。在慢性病患者中，随着非正式护理的实施，接受工具性援助与更好的医疗依从性有关。与高收入白人相比，低收入非洲裔美国人提供更多的非正式（艾滋病毒）咨询，并报告较低的咨询相关的痛苦，但更有可能停止非正式咨询。研究结果表明，非裔美国人注射吸毒者的主要支持关系不仅是重要的支持来源，但可能会影响他们的健康相关行为。该研究基于社会影响和网络资源交换理论，利用创新的社会网络方法来研究社会环境对依从行为的影响。随着抗病毒治疗在未来几年内迅速开始成为发展中国家艾滋病毒项目的一部分，网络方法可能是在资源匮乏的环境中有效、低成本、以社区为基础的依从性促进的可行选择。要求提供四年的资金，对社区抽样的500名感染艾滋病毒/艾滋病的前注射吸毒者和最多两名与艾滋病毒有关的主要支持者（n=400）进行四次半年期评估。评估将包括病毒载量和CD 4计数，对于一个子集，MEMS帽、计算机化临床和医疗服务使用记录用于验证自我报告。研究结果将有助于确定适当的目标和方法的行为依从性干预。

DESCRIPTION (provided by applicant): Disadvantaged inner-city African American communities have disproportionately high rates of substance abuse and HIV/AIDS. Among those HIV seropositive, African Americans and substance abusers tend to have suboptimal medical service use and medication adherence and more rapid illness progression. Optimal use of HAART requires near complete adherence for an indefinite period of time, necessitating behavioral interventions with long-term sustainability. Social support has consistently been found to be associated with HIV medication adherence, health service utilization, and other health-related behaviors. Literature on informal caregiving suggests that main supportive ties of the chronically ill may be important targets of medical adherence intervention. The goals of the proposed study are to examine the role of main supportive ties among injection drug users (IDUs) in promoting and impeding HIV medical service utilization and HAART adherence, and to develop, pilot, and manualize a culturally appropriate adherence promotion intervention based on these findings. The proposed study builds on our research team's extensive prior research on IDUs' informal HIV caregiving, social networks, HIV adherence, and successful prevention intervention research, medical adherence in vulnerable populations. Most care for the chronically ill is provided informally by family and friends. Among the chronically ill, receipt of instrumental assistance, as informal care is operationalized, is associated with better medical adherence. Low income African Americans compared to higher income whites provide more informal (HIV) caregiving and report lower caregiving-related distress, yet are more likely to cease informal caregiving. Findings have demonstrated that African American IDUs' main supportive ties are not only important sources of support but may influence their health-related behaviors. The proposed study is based on theories of social influence and network resource exchange and utilizes an innovative social network approach to the examination of social environmental influences on adherence behaviors. As antiviral therapies rapidly begin to become part of HIV programs in developing countries over the next few years, network approaches may be viable options for effective, low cost, community-based adherence promotion in low resource settings. Four years funding is requested for four semi-annual assessments of a community sample of 500 former IDUs living with HIV/AIDS and up to two of their main HIV-related supporters (n=400). Assessments will include viral load and CD4 count, and for a subset, MEMS caps, computerized clinical, and medical service use records for validation of self-reports. Study findings will contribute to the identification of appropriate targets and approaches for the behavioral adherence intervention.