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）：在美国，男男性行为者 (MSM) 受 HIV 影响最严重，占每年所有新 HIV 感染者的 63% 左右。凭借高效的艾滋病毒药物治疗和持续参与艾滋病毒医疗保健，这些男男性行为者的寿命更长；到 2015 年，预计超过 50% 的美国人艾滋病毒感染者年龄将在 50 岁或以上。越来越多的证据表明，慢性疼痛在老年艾滋病毒感染者中普遍存在，并且可能与物质使用和滥用协同发生，这容易导致不参与和不保留艾滋病毒护理、不遵守艾滋病毒药物治疗和承担性风险。了解这些关系并将疼痛管理策略纳入健康干预措施中，将有助于开发基于行为的定制综合干预措施，该干预措施有可能改善疼痛管理、减少药物使用（和/或其对艾滋病毒疾病管理的干扰）并改善抗逆转录病毒疗法坚持和参与护理设计。该应用程序的目的是：(1) 通过从定性访谈中提取的患者生成主题，描述老年 HIV 感染 MSM 的慢性疼痛和药物使用/滥用的特征； (2) 确定慢性疼痛、物质使用、艾滋病毒药物依从性和性冒险之间的显着直接和中介关系，并通过定量综合评估组进行评估； (3) 通过开放试点，确定群体层面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问题，从而提高护理参与度和艾滋病毒药物依从性，并减少性行为风险。我们还将评估潜在的影响检查疼痛、药物使用、艾滋病毒治疗和性风险结果的前后差异。为了实现这些目标，我们将通过 20 次深度访谈自行生成新出现的定性主题，为 60 名感染艾滋病毒的老年男男性行为者制定全面的、专门定制的定量健康评估提供信息。横截面定性和定量数据将指定一种新颖的团体级别干预措施，将在 30 名参与者中进行试点（6组，每组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。该应用程序是已知的第一个尝试，旨在调查感染艾滋病毒的老年 MSM 中慢性疼痛与药物使用/滥用、护理参与、艾滋病毒药物依从性和性风险之间的关系。此外，这是开发团体层面的综合干预措施的首次尝试。专为感染艾滋病毒的老年男男性接触者量身定制，这是一个感染艾滋病毒的高危人群。这些发现有可能改变老年艾滋病毒感染男男性行为者的慢性疼痛和药物滥用治疗模式，并可以提高护理参与度并减少性行为风险。