Women comprise the fastest growing group of persons with AIDS. They are often diagnosed later in the disease, when antiretroviral therapy (ART) is strongly indicated. Though effective in reducing the amount of circulating HIV virus and increasing the CD4 lymphocyte count, ART regimens are complex and have numerous side effects. Near perfect adherence is required to obtain and maintain the effects, but because of regimen complexities and side effects it is difficult to achieve, particularly for women who may be caretakers for HIV+ partners and children. As women on ART begin to feel better, and resume normal activities, including sexual activities, they are expected to adhere to ART and risk reduction behaviors (RRB). Reports of poor adherence to ART are common and those related to RRB are emerging. The long-term goal of this research project is to develop nursing interventions to promote adherence to both ART and RRB in HIV+ women. The primary objective of this randomized controlled behavioral trial is to test the effect of a group motivational intervention for HIV+ women on adherence to ART and RRB. The secondary objectives are to examine the mediator effects of self-efficacy, outcome expectancy, and personal goals on adherence to ART and RRB. The innovative Motivational Group (MG) intervention has motivational interviewing (MI) as the central component. It consists of 8 90-minute sessions, 2 weeks apart, led by a nurse, and is designed to inform and motivate women to adhere to ART and use RRB consistently. Using MI techniques the nurse will facilitate the group discussion relevant to ART and/or RRB adherence. Self-efficacy, positive outcome expectancy, and effective personal goals will be fostered. The intervention will be compared to an 8-session attention equivalent control condition consisting of a health promotion program led by a nurse health educator All participants wilt be assessed at five time points--baseline, immediately and 3, 6, and 9 months after the intervention using an audio computerized self-interview (ACASI). RRB adherence will be measured by self-report. Adherence to ART will be measured by self-report, eDems caps, and a Multi Component Adherence Index. Viral load and CD4 counts will be obtained by chart review at each assessment point. Repeated measures analysis of variance will be used to test the primary hypotheses that participants in the MG condition will have higher rates of adherence to ART and RRB compared to controls. Regression analyses will be used to test the effects of the mediators. ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR008094-02
Application #
6701302
Study Section
Special Emphasis Panel (ZRG1-AARR-7 (01))
Program Officer
Hare, Martha L
Project Start
2003-03-01
Project End
2007-02-28
Budget Start
2004-03-01
Budget End
2005-02-28
Support Year
2
Fiscal Year
2004
Total Cost
$793,135
Indirect Cost
Name
Emory University
Department
Other Health Professions
Type
Schools of Nursing
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Wells, Jessica S; Holstad, Marcia M; Watkins Bruner, Deborah (2018) Sociodemographic Predictors of Anal Cancer Screening and Follow-up in Human Immunodeficiency Virus-Infected Individuals. Cancer Nurs 41:424-430
Holstad, Marcia McDonnell; Spangler, Sydney; Higgins, Melinda et al. (2016) Psychosocial Characteristics Associated with Both Antiretroviral Therapy Adherence and Risk Behaviors in Women Living with HIV. AIDS Behav 20:1084-96
McCoy, Katryna; Higgins, Melinda; Zuñiga, Julie Ann et al. (2015) Age, Stigma, Adherence and Clinical Indicators in HIV-Infected Women. HIV/AIDS Res Treat 2015:S1-S8
Hodges, Samaha; Holstad, Marcia McDonnell (2013) The Impact of a Health Promotion Educational Program on Cardiovascular Risk Factors for HIV Infected Women on Antiretroviral Therapy. J AIDS Clin Res 4:224
Dalmida, Safiya George; Holstad, Marcia McDonnell; DiIorio, Colleen et al. (2012) The meaning and use of spirituality among African American women living with HIV/AIDS. West J Nurs Res 34:736-65
Holstad, Marcia McDonnell; Diiorio, Colleen; McCarty, Frances (2011) Adherence, sexual risk, and viral load in HIV-infected women prescribed antiretroviral therapy. AIDS Patient Care STDS 25:431-8
Holstad, Marcia McDonnell; DiIorio, Colleen; Kelley, Mary E et al. (2011) Group motivational interviewing to promote adherence to antiretroviral medications and risk reduction behaviors in HIV infected women. AIDS Behav 15:885-96
Dalmida, Safiya George; Holstad, Marcia McDonnell; Diiorio, Colleen et al. (2011) Spiritual Well-Being and Health-Related Quality of Life Among African-American Women with HIV/AIDS. Appl Res Qual Life 6:139-157
Holstad, Marcia McDonnell; Foster, Victoria; Diiorio, Colleen et al. (2010) An examination of the psychometric properties of the Antiretroviral General Adherence Scale (AGAS) in two samples of HIV-infected individuals. J Assoc Nurses AIDS Care 21:162-72
Dalmida, Safiya George; Holstad, Marcia McDonnell; Diiorio, Colleen et al. (2009) Spiritual well-being, depressive symptoms, and immune status among women living with HIV/AIDS. Women Health 49:119-43

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