Improving retention in care for persons with HIV who use substances by increasing acceptance and reducing stigma

通过提高接受度和减少耻辱来提高对使用药物的艾滋病毒感染者的护理保留率

• 批准号: 10409767
• 负责人: Ethan Moitra
• 金额: $ 24.21万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10409767
• 关键词: Acquired Immunodeficiency Syndrome; Appointment; Attention; Behavior; Behavior Therapy; Behavioral; Caring; Chronic; Clinic; Clinical; Cocaine; Cognition; Cognitive Therapy; Collaborations; Communicable Diseases; Communities; Crack Cocaine; Data; Disclosure; Distress; Drug usage; Epidemic; Evaluation; Feeling; Fright; Goals; Guilt; HIV; Health Personnel; Human; Individual; Intervention; Investigation; Life; Mediating; Medical; Methamphetamine; Modeling; National Institute of Drug Abuse; Newly Diagnosed; Opioid; Outcome; Participant; Pathway interactions; Patient Dropouts; Patients; Persons; Physicians; Population; Prevalence; Primary Health Care; Process; Psychologist; Psychotherapy; Public Health; Randomized Controlled Trials; Recording of previous events; Research; Risk; Sampling; Service setting; Services; Shame; Stigmatization; Substance Use Disorder; Substance abuse problem; Sum; Techniques; Therapeutic Effect; Therapeutic Intervention; Thinking; Treatment Efficacy; Viral; Viremia; Visit; Work; antiretroviral therapy; base; brief intervention; cohort; comorbidity; cost; design; experience; health disparity; improved; innovation; medical appointment; mortality; multi-site trial; outreach; prevent; primary outcome; programs; psychologic; racial and ethnic disparities; recruit; remote delivery; research study; response; skills; social stigma; substance abuse treatment; substance use; telehealth; transmission process; treatment adherence; treatment as usual; treatment services; willingness

PROJECT SUMMARY/ABSTRACT As many as 50% of people with HIV (PWH) are not in regular HIV primary care in the U.S. This is particularly common for PWH who use substances such as cocaine, methamphetamines, and opioids. PWH who are not consistently retained in care are at risk for: delayed antiretroviral treatment (ART) initiation, reduced ART adherence, unsuppressed viremia, and mortality. Moreover, poor retention means effective ART cannot be leveraged to prevent further HIV transmission. The long-term goal is to develop impactful, brief intervention techniques that can be easily integrated into usual care practices to enhance HIV care retention. The objective of this proposal, which is the next step in attaining the long-term goal, is to adapt and refine an existing retention intervention in the context of an open trial and a small randomized controlled trial. We will adapt a brief, 2-session acceptance-based behavioral therapy (ABBT) intervention to enhance retention in HIV care for people who use substances by targeting stigma. ABBT promotes an accepting stance towards life’s challenges and encourages participants to thoughtfully disclose the serostatus and/or substance abuse problems as a behavioral step towards challenging stigmatization fears. The central hypothesis is that increased tolerance of stigmatization, facilitated through increased acceptance of HIV status and substance abuse behaviors, will increase PWH’s longitudinal commitment to care. The aims of this proposal are: (1) To use an iterative process to refine ABBT for substance using, out-of- care PWH by conducting an open trial in English-speakers (n=7) and monolingual Spanish speakers (n=3); and, (2) To conduct a pilot randomized controlled trial (n = 50; incl. 10 Spanish speakers) of ABBT vs. Treatment-as-Usual (TAU). Primary outcome will be retention in care. The sample will consist of 60 HIV patients who have not attended a medical visit in at least 9 months at our infectious diseases clinic in Providence, R.I. The approach is innovative in that it departs from the status quo by using brief acceptance- based psychotherapy techniques, delivered by telehealth, to increase acceptance of HIV status and substance abuse problems and promoting careful and thoughtful disclosure as a specific mechanism to support retention. Additionally, ABBT will be adapted for monolingual Spanish speakers as this cohort of PWH needs more research attention. Upon successful completion of the proposed R34 research, this study will contribute significant actionable data that will lay the groundwork for a large-scale investigation of ABBT for out-of-care PWH who use substances.

项目摘要/摘要 在美国，多达50％的艾滋病毒（PWH）不在常规的艾滋病毒初级保健中 对于使用可卡因，甲基苯丙胺和阿片类药物等物质的PWH，特别是常见。 PWH 没有一贯保留在护理中的人面临：延迟的抗逆转录病毒治疗（ART）倡议， 降低艺术依从性，不受限制的病毒血症和死亡率。而且，保留率差意味着有效的艺术 无法杠杆以防止进一步的艾滋病毒传播。长期目标是发展有影响力的简短 可以轻松整合到通常的护理实践中以增强艾滋病毒护理保留率的干预技术。 该提案的目的是参加长期目标的下一步，是适应和完善 在开放试验和小型随机对照试验的背景下，现有的保留干预。我们将 适应简短的，两项验收的行为疗法（ABBT）干预措施以增强艾滋病毒的保留率 照顾通过瞄准污名来使用物质的人。 ABBT促进了对生活的接受立场 挑战并鼓励参与者思考披露血清和/或药物滥用 问题是朝着挑战污名化的恐惧的行为步骤。中心假设是 通过增加接受HIV状况和物质来制备的污名化耐受性增加 滥用行为将增加PWH对护理的纵向承诺。 该提案的目的是：（1）使用迭代过程来完善使用ABBT，用于使用，以外 通过在英语说话者（n = 7）和单语言使用者（n = 3）进行公开试验来进行护理PWH； （2）进行了一个随机对照试验（n = 50；包括10位西班牙语者）的ABBT vs。 治疗与普遍（tau）。主要结果将是保留护理。样本将包括60 HIV 在我们的感染疾病诊所中至少9个月没有参加过医疗访问的患者 R.I. Providence。该方法具有创新性，因为它通过简短的接受 - 通过远程医疗提供的基于心理治疗技术，以增加对艾滋病毒状况和物质的接受 滥用问题，并促进仔细和周到的披露，作为支持保留的特定机制。 此外，ABBT将适用于单语的西班牙语者，因为PWH需要更多 研究注意力。成功完成拟议的R34研究后，本研究将有助于 大量可操作的数据将为ABBT进行大规模研究奠定基础 使用物质的PWH。