Integrated Behavioral Treatment for Chronic Pain/Drug Use in Older MSM with HIV

针对老年 HIV 感染男男性行为者的慢性疼痛/药物使用的综合行为治疗

基本信息

批准号：
9000143
负责人：
Conall Michael O'Cleirigh
金额：
$ 17.57万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-02-01 至 2017-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9000143
关键词：
Address Adherence Affect Age-Years Aging Alcohol or Other Drugs use American Behavior Behavior Therapy Behavioral Caring Centers for Disease Control and Prevention (U.S.)Characteristics Comorbidity Data Development Disease Management Drug usage Elderly Epidemic HIV HIV Infections Health Health Benefit Healthcare Intervention Interview Life Literature Longevity Mediating Mental Health Methodology Modeling Neurofibromin 2 Outcome Pain Pain management Participant Patients Persons Pharmaceutical Preparations Play Population Process Public Health Quality of life Randomized Clinical Trials Reporting Research Risk Role Sampling Secondary Prevention Specific qualifier value Staging Substance abuse problem Testing Viral Load result base chronic pain design follow-up forging improved insight medication compliance men men who have sex with men novel reduced substance use response sex sexual risk taking substance abuse treatment therapy development transmission process treatment effect treatment strategy

项目摘要

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) in the US are most heavily affected by HIV, representing ~63% of all new HIV infections annually. With highly effective HIV medication and consistent engagement in HIV health care, these MSM are living longer; by 2015 it is estimated that more than 50% of Americans living with HIV will be 50 years of age or older. Evidence is emerging that chronic pain is prevalent in older HIV-infected patients and likely occurs synergistically with substance use and abuse, which predispose to non-engagement and non-retention in HIV care, non-adherence to HIV medications and sexual risk taking. Understanding these relationships and incorporating pain management strategies in health interventions will forge the development of a tailored behavioral-based, integrated intervention that has the potential to improve pain management, reduce substance use (and/or its interference in HIV disease management) and improve ART adherence and engagement in care Design. The aims of this application are to: (1) characterize chronic pain and substance use/abuse in older HIV-infected MSM, through patient generated themes extracted from qualitative interviews; (2) identify significant direct and mediated relationships between chronic pain, substance use, HIV medication adherence and sexual risk-taking, assessed via a quantitative comprehensive assessment battery; and, (3) determine the feasibility and acceptability of a group-level, integrated behavioral intervention to address chronic pain and substance abuse that could increase engagement in care and HIV medication adherence and decrease sexual risk taking, through an open pilot. We will also assess the potential for an effect examining pre-post differences on pain, substance use, HIV treatment, and sexual risk outcomes. To achieve these aims, self-generated emerging qualitative themes from 20 in-depth interviews will inform the development of a comprehensive, specifically tailored quantitative health assessment for 60 older HIV-infected MSM. The cross-sectional qualitative and quantitative data will specify a novel group-level, intervention to be piloted with 30 participants (6 groups of 5 men). These results will set the stage for a R34 RCT application to estimate controlled treatment effect sizes. This application is the first known attempt to investigate the behavioral processes involved in the association of chronic pain with substance use/abuse, engagement in care, HIV medication adherence and sexual risk taking among older MSM living with HIV. Furthermore, this is the first attempt to develop a group- level, integrated intervention specifically tailored to older HIV-infected MSM, an at-risk group who are disproportionately represented with HIV. These findings have the potential to change chronic pain and substance abuse treatment paradigms for older HIV-infected MSM and could improve engagement in care and decrease sexual risk taking.

描述（由申请人提供）：美国与男性发生性关系的男性受艾滋病毒的影响最大，占所有新艾滋病毒感染的约63％。通过高效的艾滋病毒药物和在艾滋病毒医疗保健中的持续参与，这些MSM的寿命更长。到2015年，据估计，超过50％的艾滋病毒的美国人将年满50岁或以上。有证据表明，慢性疼痛在年龄较大的HIV患者中普遍存在，并且可能与药物使用和滥用协同作用，这使HIV护理中的不参与和不保留艾滋病毒护理，不遵守HIV药物和服用性风险。了解这些关系并将疼痛管理策略纳入健康干预措施，将开发出量身定制的基于行为的综合干预措施，该干预措施有可能改善疼痛管理，减少药物使用（和/或在HIV疾病管理中的干扰）并改善艺术依从性和参与护理设计。该应用的目的是：（1）通过从定性访谈中提取的患者产生的主题来表征慢性疼痛和滥用较早的HIV感染的MSM的慢性疼痛和滥用；（2）通过定量的综合评估电池评估慢性疼痛，药物使用，艾滋病毒药物依从性和性冒险之间的显着直接和介导的关系；（3）确定群体级，综合行为干预的可行性和可接受性，以解决慢性疼痛和药物滥用，这可能会通过开放的飞行员通过开放的飞行员来增加对护理和HIV药物的依从性并减少性风险的参与。我们还将评估效果的潜力检查疼痛，药物使用，艾滋病毒治疗和性风险结果的前检查前差异。为了实现这些目标，来自20次深入访谈的自我生成的新兴定性主题将为60个较老的HIV感染的MSM提供全面，专门针对60个较年长的HIV的定量健康评估的开发。横截面定性和定量数据将指定一个新颖的群体级别，干预措施将与30个参与者进行。（6组5人）。这些结果将为R34 RCT应用奠定基础，以估计受控治疗效果的大小。该应用是调查慢性疼痛与药物使用/滥用，从事护理，艾滋病毒药物依从性和性风险相关的行为过程的第一次已知尝试，在患有艾滋病毒的年龄较大的MSM中服用性风险。此外，这是开发小组级，集成干预的第一次尝试专门针对较老的HIV感染的MSM量身定制的，这是一个高风险的组，与HIV相比不成比例。这些发现有可能改变感染了HIV的MSM的慢性疼痛和药物滥用治疗范例，并可以改善护理的参与度并减少性风险服用。