Through December 2003, more than 57,000 persons in the U.S. were 55 years of age or older when they were diagnosed with AIDS. Because AIDS researchers have focused primarily on younger persons living with HIV disease, there are very few age-appropriate interventions to enhance life quality in older persons living with HIV/AIDS. From 2001-2004, the P.I. was supported by NIA to pilot test a coping improvement group intervention delivered using teleconference technology with 90 HIV-infected older adults. Outcome analyses revealed that the intervention reduced participants'levels of psychological symptoms, life-stressor burden, and use of maladaptive coping strategies and increased coping self-efficacy. Following the success of our pilot research, this application proposes to evaluate the impact of a telephone-delivered, coping improvement group intervention on the adjustment efforts of 360 ethnically- and geographically-diverse HIV- infected older adults in relation to a telephone-delivered, information support group intervention and a standard of care comparison condition. Similar to our pilot intervention, the coping intervention will be guided by Lazarus and Folkman's (1984) Transactional Model of Stress and Coping and will use cognitive- behavioral principles to improve skills in stress appraisal, coping decisions, and obtaining social support. Participants will complete self-administered surveys at pre-intervention, post-intervention, and 4- and 8- month follow-up that assess the prevalence of comorbid health conditions, cognitive functioning, psychiatric distress, life-stressor burden, ways of coping, coping self-efficacy, and social support. Following the conduct of traditional statistical intervention outcome and mediational analyses, the intervention's efficacy will be further evaluated by identifying the proportion of intervention participants who report clinically-meaningful changes on key outcome measures. Furthermore, this research will evaluate the process by which teleconference-delivered interventions produce beneficial changes in this group (e.g., what characteristics of the telephone group environment are most related to beneficial changes in outcome measures?). If successful, this research will identify a telephone-delivered intervention that can improve life quality in HIV- infected older adults who might otherwise lack access to mental health support services due to geographic isolation, physical limitations, and confidentiality concerns.
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