CHANGES

NOTE: This study has ended.

Background

The CHANGES Project is a coping intervention, Coping Effectiveness Training (CET), designed to assist HIV+ gay men in sustaining psychological health despite the ongoing stress associated with HIV infection. Helping HIV+ people to reduce stress and adhere to their medical care may in turn help to reduce their risky behavior. In this sense, “HIV prevention” is not just about preventing viral transmission, but also about preventing disease progression and the mental health consequences of HIV. The study provides a setting to test new advances in stress and coping theory, and its findings will extend to people living with other chronic diseases.

Study description

CHANGES is a randomized clinical trial of an innovative, theory-based coping intervention. The research questions address the problems of maintaining intervention effects, evaluating intervention effects on quality of life, health care utilization and adherence to medical care, and testing new advances in stress and coping theory. Approximately 200 HIV+ gay men in the Bay Area were enrolled and assessed at baseline and at 3-, 6-, and 12-month follow-up intervals.

See the 4-page Science-to-Community report for an overview of the project.

For further detail please see the intervention manual: Caution: these are large PDF files and may take a while to download.

Findings

CET participants demonstrated greater improvement in psychological distress and well-being (e.g., negative morale, coping self-efficacy, personal growth, positive states of mind) than did the control group participants during the 3-month intervention phase. These differences were maintained during the 9-month maintenance phase.

The issue of side effects and symptoms, particularly fatigue, has emerged as a major topic in relationship to adherence to HIV care and continuation in medical treatment. A central challenge in HIV clinical trials and treatment is medication “burnout” from patients struggling to manage HIV’s intrusions on their quality of life. That 87.5% of our CHANGES Project participants report at least some level of fatigue underscores the importance of this problem. Relationships between fatigue and our measures of psychological distress and quality of life demonstrate inverse associations between fatigue and a number of important facets of adaptive psychological functioning. These relationships suggest the need for and also begin to suggest direction for interventions related to fatigue management.

An additional emerging topic is the increasing number of older HIV+ adults. Older adults with HIV/AIDS, often having lived with the condition longer, are more likely to be confronted with the stress of managing further-advanced HIV disease than their younger counterparts. Older persons are also more likely to have lower levels of social support and higher levels of distress than younger persons with HIV. In our CHANGES Project population, the influence of social support on negative and positive moods was greater among older than younger participants. Accordingly, special efforts to create effective and sustainable social support interventions may be particularly beneficial for older persons living with HIV.

Staff

Margaret Chesney, Principal Investigator; Susan Folkman, Co-Principal Investigator; Don Chambers, Co-Investigator; Joey Taylor, Project Director; Margaret Nettles, Tom Holt and Laurie Hessen, Clinical Supervisors; Steve Baum, Richard Buggs, Brian Dietrich, Janelle Eckhardt, Chaya Rivka Mayerson, Bettina O’Brien, Joshua Schwartz, Norma Jean Van Volkinburg, and Danny Yu, Group Facilitators; Derek Aspacher and Neal Carnes, Outreach-Recruitment Coordinators; Neal Carnes, Ann Laak, Larry Lariosa, Patrick Letellier, Tom Slama and Shay Storey, Interviewers.

For more information about the CHANGES Project, please contact:

Joey Taylor
CAPS
50 Beale Street, Suite 1300
San Francisco, CA 94105
(415) 597- 9189
(415) 597-9213 – fax
Joey.Taylor at ucsf.edu

Last modified: October 22, 2012