The purpose of this revised application for a 5-year mentored research scientist development award (KO1) on HIV adherence is to conduct research and training activities to advance the candidate's development as an independent behavioral scientist. The proposed research plan includes a series of studies that build upon each other in the area of HIV medication adherence. Study One is a cross sectional study of the relationship of normal and abnormal personality and treatment adherence in 156 HIV+ clinic patients, with consideration of key covariates such as psychopathology, substance use and substance disorders, readiness for adherence, and social support. Study Two includes two components: a prospective study of risk-related and health-promoting behaviors and their relationship to HIV treatment adherence, and a method development study to refine and validate a time-line follow-back method of assessing medication adherence using a novel telephone reporting system to record patient-reported adherence in 128 subjects. Study Three will investigate the necessary and sufficient components of combination adherence interventions. This study is a 3 level, randomized, 12 week prospective control group investigation of psychosocial adherence interventions to be conducted in 189 HIV+ clinic patients who are initiating highly active antiretroviral therapy (HAART) or changing a HAART regimen. This study will build upon results from studies One and Two in methods and key variables to be considered. Interventions will include treatment as usual in group 1, prospective self monitoring of adherence in Group 2, and a """"""""trial run"""""""" of the selected regimen using vitamins added to prospective self monitoring in Group 3. Results from these studies will provide significant needed information to improve adherence among HIV+ patients taking HAART, and will provide the structure and experiences for the candidate to develop an independent research program on treatment adherence.
