This application is in response to the Program Announcement """"""""Coping with AIDS as a Chronic Long-Term Illness"""""""" (PA-99-026) and requests 3 years of support to develop and field-test an intervention to enhance HIV treatment adherence among persons with low-literacy skills. Guided by the Information-Motivation-Behavioral Skills model of health promoting behaviors and principles established for improving health behaviors in persons with low-literacy, we will conduct 3 phases of research: (1) Perform initial interviews and focus groups with HIV positive persons with low-literacy and their health care providers to establish barriers to treatment adherence and strategies to improve adherence for persons with low-literacy. This first phase of research will also develop informed consent and adherence assessment procedures for low-literacy populations; (2) Test the feasibility of a pictograph-based information, motivation, and behavioral skills building treatment adherence intervention with a small sample of persons with HIV infection who demonstrate poor literacy skills, and test the acceptability of the new intervention model with health care providers; and (3) Conduct a randomized field test to determine the potential efficacy of the pictograph-based intervention with 80 HIV seropositive persons with low-literacy. Participants in the field test will be randomly assigned to either receive the newly developed intervention or assigned to a wait-list comparison group. Following a six-month follow-up period, we will test for differences between groups on self-reported HIV treatment adherence measures as well as variables relevant to testing the Information, Motivation, Behavioral Skills adherence intervention model. Results of the proposed research will provide critical information about improving HIV treatment adherence with low-literacy populations that is needed prior to conducting larger and more expensive clinical trials.
