health improvement for baltimore youth

Conditions: HIV; Adolescent Development; Adolescent Behavior; Medication Adherence

Summary: preliminary data from the investigators' national center for complementary and alternative medicine (nccam)-funded r21 on mindfulness-based stress reduction (mbsr) in hiv-infected youth suggest an association between mindfulness and improved self-regulation and medication adherence. this randomized, controlled trial will help the investigators to better understand the specific impact of mbsr on hiv medication and treatment adherence in hiv-infected youth, and the efficacy of mbsr in the amelioration of stress and improved self-regulation.

despite remarkable advances in hiv medication effectiveness, adherence to hiv treatment recommendations is alarmingly poor, resulting in preventable morbidity and mortality. it is estimated that 26-72% of hiv-infected adolescents are non-adherent to their hiv medications and 22-33% are non-adherent with scheduled health care visits. hiv treatment non-adherence puts individuals at markedly increased risk for illness related to hiv itself and a variety of opportunistic infections, as well as at increased risk of spreading hiv. preliminary data from the investigators' nccam-funded r21 on mindfulness-based stress reduction (mbsr) in hiv-infected youth suggest an association between mindfulness and improved medication adherence, as well as enhanced self-regulatory processes (coping, psychological function, and cognitive function). this two-armed randomized, controlled trial will help the investigators to better understand the specific impact of mbsr on hiv medication and treatment adherence in hiv-infected youth, and the efficacy of mbsr in the amelioration of stress and improved self-regulation. the aims of the study are as follows: primary objective investigators hypothesize that mbsr vs. active control program (ht) participation will be associated with: • (h1) improved hiv medication adherence (self-report validated by hiv viral load) at 3 months, 6 months, and 12 months secondary objectives investigators also hypothesize that mbsr vs. active control program (ht) participation will be associated with: * (h2) improved coping at 3, 6, and 12 months * (h3) improved psychological functioning at 3, 6, and 12 months * (h4) improved cognitive functioning at 3, 6, and 12 months investigators will also explore: * associations (and potential mediation) among mindfulness, self-regulation, and hiv medication adherence and * using qualitative methods, experience with mbsr, hiv treatment adherence, as well as reasons for non-participation in the study and non-attendance of program sessions to inform future implementation planning. * gender differences in the effects of mbsr versus ht on emotion regulation and physiological responses to stressful stimuli.

Eligibility criteria:
inclusion criteria: * 13-24 years of age * english speaking * receiving care at the adolescent outpatient clinics at johns hopkins children's center (jhcc/university of maryland medical center (ummc)/moore clinic * positive for hiv and aware of his/ her status * prescribed anti-retroviral therapy (art) * able to attend and participate in the 9 week program sessions exclusion criteria: * patient currently exhibits significant psychological, developmental, or behavioral issues as assessed by the site clinical staff * participated in a previous mbsr program or studies exclusion criteria for supplement study: • patient is transgender

Keywords: treatment adherence mental health well-being emerging adults youth