Engaging HIV Patients in Primary Care by Promoting Acceptance

通过促进接受来让艾滋病毒患者参与初级保健

• 批准号: 8466640
• 负责人: Ethan Moitra
• 金额: $ 21.56万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-03-21 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8466640
• 关键词: AIDS prevention; AIDS/HIV problem; Adherence; Adverse effects; Aftercare; Anti-Retroviral Agents; Anxiety; Appointments and Schedules; Attention; Behavior Therapy; Behavioral; Caring; Case Manager; Cessation of life; Clinic; Clinical; Clinical Trials; Cognition; Communities; Competence; Complex; Consent; Counseling; Development; Disclosure; Distress; Drops; Enrollment; Family; Frequencies; Friends; Fright; Goals; Guidelines; HIV; HIV Seropositivity; HIV diagnosis; Individual; Intervention; Life; Link; Measures; Mediating; Medical; Modeling; Outcome; Participant; Pathway interactions; Patients; Perception; Pharmaceutical Preparations; Plant Roots; Population; Preparation; Primary Health Care; Procedures; Process; Process Assessment; Professional counselor; Property; Psychometrics; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Research; Research Design; Risk; Sampling; Self Management; Services; Sexual Partners; Social support; Stigmatization; Structure; Techniques; Testing; Therapeutic Effect; Training Programs; Treatment Efficacy; Validity and Reliability; Visit; Work; base; brief intervention; care seeking; cost; experience; follow-up; improved; indium arsenide; medical appointment; medication compliance; novel; pilot trial; primary care setting; primary outcome; psychologic; public health relevance; response; secondary outcome; social stigma; stressor; transmission process; treatment as usual; willingness

DESCRIPTION (provided by applicant): The challenge of living with HIV involves long-term, complex self-management as well as consistent engagement in medical care. Engagement represents a patient's longitudinal commitment to care and permits People Living With HIV/AIDS (PLWHA) to take advantage of effective medical treatments. Yet too often patients new to care drop out of care or fail to maintain a regular appointment schedule. This proposal targets exploring and increasing acceptance of one's HIV status as a means to maximize engagement. Acceptance-based interventions target experiential avoidance, or an individual's attempts to avoid distressing internal and external experiences. For PLWHA, this might include anxiety about pending CD4 lab results or fear of stigmatization in one's community due to HIV diagnosis. Based on our prior work with PLWHA and acceptance-based interventions to keep patients in care in other populations, we suggest reductions in experiential avoidance will allow PLWHA to gain self-acceptance of serostatus and overcome engagement barriers. Our pilot development of a brief acceptance-based behavior therapy (ABBT) for antiretroviral adherence rooted in acceptance and commitment therapy (ACT), showed feasibility and acceptability in the primary care setting. However, this trial suggested that any improvement in medication adherence required prior engagement in medical services, the focus of the current proposal. Inevitably, life with HIV is stressful for a variety of reasons (e.g., medication side effects, shae, etc.); we suggest acceptance provides PLWHA with a framework to tolerate these stressors in the service of prioritizing a value-driven approach to engaging in medical care. The objectives of this R34 Clinical Trial Planning proposal are to (a) adapt ABBT to a two-session, individual-based acceptance-focused intervention to be delivered by case managers to diverse HIV+ primary care patients; (b) using an iterative open trial (n = 10), establish the structure, content acceptability, and feasibility of the adapted intervention; (c) conduct a randomized pilot trial ina sample of 40 ethnically/racially diverse patients who are new to primary care to establish the efficacy of ABBT in comparison to an treatment- as-usual (TAU) control condition, as preparation for an eventual large-scale (R01), adequately powered randomized clinical trial with the same research design; and, (d) examine preliminary psychometric properties of a novel measure of willingness to disclosure HIV status to non-sex partners. The clinical and public health impact of this project will be the development of a simple, low-cost, disseminable intervention for HIV patients new to care that enhances a patient's longitudinal commitment to care so s/he can obtain effective medical treatments that will prolong survival and improve quality of life.

描述（由申请人提供）：艾滋病毒的生活挑战涉及长期，复杂的自我管理以及一致参与医疗服务。订婚代表了患者对护理的纵向承诺，并允许患有艾滋病毒/艾滋病的人（PLWHA）利用有效的医疗治疗。然而，新手的病人通常会辍学或无法维持定期的任命时间表。该提案针对探索并增加对自己的艾滋病毒状况的接受，以此作为最大化参与的一种手段。基于接受的干预措施针对体验避免，或者个人避免痛苦的内部和外部经历的尝试。对于PLWHA，这可能包括焦虑不安的CD4实验室结果或由于HIV诊断而害怕在社区中受到污名化。基于我们先前与PLWHA的工作和基于接受的干预措施，以使患者在其他人群中保持护理状态，我们建议减少体验式避免的情况，这将使PLWHA能够获得对血清的自我接受并克服参与障碍。 我们对基于接受和承诺疗法（ACT）的抗逆转录病毒依从性（ACT）进行简短接受行为疗法（ABBT）的试点开发在初级保健环境中显示出可行性和可接受性。但是，该试验表明，依从性的任何改善都需要事先参与医疗服务，这是当前提案的重点。不可避免地，出于多种原因（例如，药物副作用，Shae等），艾滋病毒的生活压力很大；我们建议接受为PLWHA提供一个框架，以容忍这些压力源，以优先考虑从事医疗服务的价值驱动方法。 该R34临床试验计划建议的目标是（a）将ABBT调整为两项，基于个人接受的干预措施，案例经理将向不同的HIV+初级保健患者提供； （b）使用迭代开放试验（n = 10），建立适应性干预的结构，内容可接受性和可行性； （c）进行随机试验试验INA样本，包括40种种族/种族多样的患者，这些患者是新的初级保健，与治疗 - 平常（TAU）控制条件相比，以确立ABBT的疗效，作为最终大规模（R01）的准备，并具有相同的研究设计的最终大型随机临床试验； （d）检查对非性别伴侣披露HIV状况的新颖措施的初步心理测量特性。 该项目的临床和公共卫生影响将是针对新手护理的艾滋病毒患者的简单，低成本，可忽视的干预措施的发展，从而增强了患者对护理的纵向承诺，因此他/他可以获得有效的医疗治疗，以延长生存并改善生活质量。