This application proposes a structural ecosystemic intervention for HIV medical adherence (SETA) in recently sober women. Recently sober is defined in this proposal as DSM IV drug dependence or abuse within the last year and but not in the last 60 days. The 4-month intervention targets women, their families, and their social networks as the building blocks for the infrastructure to support HIV medical adherence, reduction in HIV transmission risk behaviors and drug abuse relapse prevention. An important part of this infrastructure is a constructive relationship between the HIV infected women and their health care system. This is buttressed with attention to 1) reducing the negativity former drug users experience from their families, 2) establishing firm boundaries to separate the women from drug using family and friends who can frequently trigger relapse to drug use, 3) for women with children, restoring the women=s role as a parent, improving her parenting abilities, and enhancing the support she receives for parenting functions and 4) developing well integrated, multiply connected pro-social support systems to reinforce the recovery process and maintain healthy behaviors including HIV transmission risk and HIV medical adherence. The study will enroll 196 women and randomly assign them to either the SETA intervention, or an HIV health group designed to match SETA for attention. Women are assessed at 2-month intervals for a period of 12 months. HIV medical adherence is measured by self-report, MEMS CAP, and viral load. The SETA intervention is hypothesized to improve HIV medical adherence relative to the HIV health control group. The hypothesized mediating factors are: family functioning, social support, patient-doctor interactions, health beliefs, and drug abuse relapse. The effects of the intervention and the hypothesized mediators will be tested using Hierarchical Linear Modeling. This will be the first award for this investigator.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
7R01DA015004-05
Application #
7177247
Study Section
Special Emphasis Panel (ZRG1-AARR-8 (01))
Program Officer
Lambert, Elizabeth
Project Start
2002-09-10
Project End
2007-07-31
Budget Start
2006-02-01
Budget End
2006-07-31
Support Year
5
Fiscal Year
2005
Total Cost
$921,291
Indirect Cost
Name
Florida International University
Department
Type
Other Domestic Higher Education
DUNS #
071298814
City
Miami
State
FL
Country
United States
Zip Code
33199
McCabe, Brian E; Feaster, Daniel J; Mitrani, Victoria B (2014) Health correlates of co-occurring substance use for women with HIV in cocaine use recovery. Addict Behav 39:725-8
Feaster, Daniel J; Reznick, Olga Grinstead; Zack, Barry et al. (2013) Health status, sexual and drug risk, and psychosocial factors relevant to postrelease planning for HIV+ prisoners. J Correct Health Care 19:278-92
Reznick, Olga Grinstead; McCartney, Kathleen; Gregorich, Steven E et al. (2013) An ecosystem-based intervention to reduce HIV transmission risk and increase medication adherence among inmates being released to the community. J Correct Health Care 19:178-93
Mitrani, Victoria B; McCabe, Brian E; Burns, Myron J et al. (2012) Family mechanisms of structural ecosystems therapy for HIV-seropositive women in drug recovery. Health Psychol 31:591-600
Feaster, Daniel; Brincks, Ahnalee; Robbins, Michael et al. (2011) Multilevel models to identify contextual effects on individual group member outcomes: a family example. Fam Process 50:167-83
Mitrani, Victoria B; Feaster, Daniel J; Weiss-Laxer, Nomi S et al. (2011) Malaise, motivation and motherhood: predictors of engagement in behavioral interventions from a randomized controlled trial for HIV+ women in drug abuse recovery. AIDS Behav 15:396-406
Feaster, Daniel J; Mitrani, Victoria B; Burns, Myron J et al. (2010) A randomized controlled trial of Structural Ecosystems Therapy for HIV medication adherence and substance abuse relapse prevention. Drug Alcohol Depend 111:227-34
Feaster, Daniel J; Burns, Myron J; Brincks, Ahnalee M et al. (2010) Structural Ecosystems Therapy for HIV+ African-American women and drug abuse relapse. Fam Process 49:204-19
Mitrani, Victoria B; McCabe, Brian E; Robinson, Carleen et al. (2010) Structural Ecosystems Therapy for recovering HIV-positive women: child, mother, and parenting outcomes. J Fam Psychol 24:746-55
Brincks, Ahnalee M; Feaster, Daniel J; Mitrani, Victoria B (2010) A multilevel mediation model of stress and coping for women with HIV and their families. Fam Process 49:517-29

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