Treating Chronic Pain and Depression in HIV Patients in Primary Care Settings

在初级保健机构中治疗艾滋病毒患者的慢性疼痛和抑郁症

• 批准号: 8409713
• 负责人: Michael D Stein
• 金额: $ 22.19万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-03 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8409713
• 关键词: Achievement; Address; Adherence; Affect; Anti-Retroviral Agents; Attention; Behavior Therapy; Behavioral; Caring; Chronic Disease; Clinical; Collaborations; Community Health Centers; Comorbidity; Complex; Consent; Data; Depressed mood; Future; Goals; Growth; HIV; HIV therapy; Health education; Home environment; Individual; Infection; Intervention; Joints; Lead; Manuals; Measures; Medical; Mental Depression; Mental Health; Mental disorders; Modeling; Nurses; Outcome; Pain; Pain interference; Participant; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Phase; Population; Preparation; Primary Care Physician; Primary Health Care; Private Practice; Procedures; Process; Process Assessment; Protocols documentation; Provider; Psychologist; Quality of life; Randomized; Randomized Clinical Trials; Relative (related person); Research; Research Design; Social Workers; Specialist; Supervision; Telephone; Testing; Training; Treatment outcome; Work; arm; behavioral health; chronic depression; chronic pain; depressive symptoms; disability; effective therapy; experience; improved; meetings; novel; pilot trial; primary care setting; primary outcome; secondary outcome; treatment planning

DESCRIPTION (provided by applicant): In the era of Highly Active Antiretroviral Treatment (HAART), HIV is increasingly a chronic illness. The experience of pain now often occurs over the entire course of infection, with 30-65% of HIV patients having chronic pain that is frequent, severe, may not be reversible, and interferes with daily activities. For most, no fully effective non-pharmacological therapies exist to improve pain outcomes. Developing a novel pain treatment is complicated by the fact that among HIV patients, pain often co- occurs with depression, one of the most common mental health disorders in HIV patients. This project will develop a collaborative treatment, in which behavioral health specialists (BHS: social workers, nurses, psychologists) and primary care providers (PCPs) share a unified plan for addressing pain and depression in patients receiving HIV care in a Community Health Center primary care setting. This collaborative therapy, entitled HIVPASS (HIV Pain And Sadness Study), builds upon behavior therapy that targets a reduction in behavioral avoidance and an increase in behavioral activation to address both conditions concurrently. Achievement of the Specific Aims will occur in the context of two phases. First, we will conduct an open trial of HIVPASS (n=10). Next, we will conduct a pilot randomized clinical trial (n=30) with two treatment arms, HIVPASS and Health Education. Pain will be the primary outcome variable assessed, and depression and antiretroviral adherence will be the secondary outcome variables. The Aims of this project are: 1. To develop and refine HIVPASS so that it meets standards of feasibility and acceptability for primary care physicians (PCPs), behavioral health specialists (BHSs), and participants (open trial and pilot RCT); a. To develop, field-test, and finalize a HIVPASS manual; b. To develop a reliable measure of BHS adherence to the manual; c. To develop, field-test, and finalize BHS training and supervision procedures; 2. To refine research procedures (e.g., consent process, randomization process, and assessment procedures), and establish their feasibility and acceptability to participants (pilot RCT) while confirming recruitment goal targets. This line of work could lead to the incorporation of theoretically-driven and effective treatment for patients with pain and depression into HIV care. This would be the first empirically-tested therapy protocol that specifically integrates treatment of these conditions in HIV research. We believe that this treatment will lead to improved pain and depression outcomes in population. PUBLIC HEALTH RELEVANCE: Thirty to sixty-five percent of HIV patient have pain that interferes with daily activities, affects drug treatment outcomes, and often co-occurs with depression. This project will develop a novel collaborative treatment, in which behavioral health specialists and primary care providers share a unified plan for addressing pain and depression in HIV patients receiving primary care in private practice or Community Health Center settings. This collaborative therapy, entitled HIVPASS (HIV Pain and Sadness Study), builds upon behavior therapy that targets a reduction in behavioral avoidance and an increase in behavioral activation, and would be the first empirically-tested therapy protocol that specifically integrates treatment of pain and depression in HIV research.

描述（由申请人提供）：在高度活跃的抗逆转录病毒治疗时代（HAART），艾滋病毒越来越慢性病。现在，疼痛的经历通常发生在整个感染过程中，其中30-65％的艾滋病毒患者患有慢性疼痛，经常出现，严重，可能不可逆，并且会干扰日常活动。对于大多数人来说，没有完全有效的非药理疗法来改善疼痛结果。在艾滋病毒患者中，疼痛经常与抑郁症（HIV患者最常见的心理健康障碍之一）共同发生，这一事实使发展新颖的疼痛治​​疗变得复杂。该项目将开发一种协作治疗，在该治疗中，行为健康专家（BHS：社会工作者，护士，心理学家）和初级保健提供者（PCP）分享了一个统一的计划，以解决在社区健康中心初级保健环境中接受HIV护理的患者的疼痛和抑郁症。这种题为HIVPass（HIV疼痛和悲伤研究）的合作疗法的基于行为疗法的基础，该疗法的目标是避免行为避免行为和行为激活的增加，以同时解决这两种情况。特定目标的实现将在两个阶段的背景下发生。首先，我们将对HIVPAPS进行公开试验（n = 10）。接下来，我们将使用两个治疗臂，HIVPass和健康教育进行试点随机临床试验（n = 30）。疼痛将是评估的主要结果变量，抑郁症和抗逆转录病毒依从性将是次要结果变量。该项目的目的是：1。开发和完善HIVPass，以便符合初级保健医生（PCP），行为健康专家（BHSS）和参与者的可行性和可接受性标准（开放式试验和PILOT RCT）； 一个。开发，进行现场测试和最终确定HIVPASS手册； b。建立可靠的BHS遵守手册的衡量标准； c。制定，进行现场测试和最终确定BHS培训和监督程序； 2。要完善研究程序（例如同意过程，随机过程和评估程序），并在确认招聘目标目标的同时，确定对参与者的可行性和可接受性（Pilot RCT）。 这条线 工作可能导致理论上驱动且有效的疼痛和抑郁症患者纳入艾滋病毒护理。这将是第一个经过经验测试的治疗方案，该方案在HIV研究中专门整合了这些疾病的治疗方法。我们认为，这种治疗方法将导致人口的疼痛和抑郁症的改善。 公共卫生相关性：30％至65％的艾滋病毒患者患有疼痛，会干扰日常活动，影响药物治疗结果，并经常与抑郁症共同出现。该项目将开发一种新颖的协作治疗方法，在该治疗中，行为健康专家和初级保健提供者共享一个统一的计划，以解决在私人执业或社区健康中心环境中接受初级保健的艾滋病毒患者的疼痛和抑郁症。这种题为HIVPass（HIV疼痛和悲伤研究）的合作疗法以行为疗法为目标，该行为疗法的目标是避免行为避免行为和行为激活的增加，并且将是第一个经过经验检验的治疗方案，该方案是专门整合的 艾滋病毒研究中疼痛和抑郁的治疗。