Brief Acceptance-Based Retention Intervention for Newly Diagnosed HIV Patients

针对新诊断的艾滋病毒患者的基于接受的简短保留干预措施

• 批准号: 9927347
• 负责人: Ethan Moitra
• 金额: $ 66.86万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-03 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9927347
• 关键词: Acquired Immunodeficiency Syndrome; Adherence; Attention; Behavior Therapy; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Clinical; Cognition; Cognitive Therapy; Communities; Continuity of Patient Care; Data; Disclosure; Dropout; Drops; Education; Enrollment; Ensure; Esthesia; Feeling; Fright; Future; Geography; Goals; Guidelines; HIV; HIV diagnosis; Human immunodeficiency virus test; Intervention; Mediating; Medical; Memory; Modeling; National Institute of Mental Health; Newly Diagnosed; Outcome; Participant; Patient Dropouts; Patients; Persons; Prevalence; Privacy; Psychotherapy; Public Health; Publishing; Quality of life; Randomized; Randomized Controlled Trials; Research; Risk; Sampling; Services; Site; Social support; Stigmatization; Subgroup; Support System; Techniques; Telephone; Testing; Therapeutic Effect; Therapeutic Intervention; Thinking; Time; Viremia; Visit; antiretroviral therapy; arm; attentional control; base; coping; cost; ethnic diversity; experience; follow-up; improved; innovation; intervention cost; medical appointment; member; mortality; pilot trial; prevent; primary outcome; programs; recruit; research study; response; retention rate; secondary outcome; social stigma; transmission process; treatment adherence; treatment as usual; virology; willingness

Project Summary/Abstract Drop-out rates from medical clinics in the first months following linkage to HIV care are as high as 50%, with 31-46% of patients dropping out after the first visit. People Living with HIV (PLWH) 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 improve the HIV care cascade by developing behaviorally-based interventions with broad applicability that can be executed with minimal cost and effort in community-based HIV care medical settings. The objective of this proposal, which is the next step in attaining the long-term goal and building on our successful R34 study, is to conduct a fully powered, randomized controlled trial (RCT) to assess the efficacy of a brief, 2-session acceptance-based behavioral therapy (ABBT) intervention to enhance retention in HIV care. The central hypothesis is that participants' informed disclosure of HIV status to members of their support system, facilitated through increased acceptance of HIV status early in medical care, will increase their longitudinal commitment to care. The aims of this proposal are: (1) To test, in a 2-arm RCT, the efficacy of the ABBT intervention on retention in care and virologic suppression (primary outcomes); and, ART adherence, disclosure of HIV status, perceived social support, HIV stigmatization (secondary outcomes), relative to an Enhanced-Treatment-as- Usual condition; and, (2) To examine the degree to which retention in HIV care and virologic suppression are mediated by (a) increased HIV acceptance (and decreased HIV experiential avoidance) and (b) increased willingness to disclose HIV status. The sample will consist of 270 HIV patients who are new to care, recruited from two large, geographically and ethnically diverse HIV medical care settings in Providence, R.I., and New Orleans, L.A. The approach is innovative in that it departs from the status quo by using brief acceptance-based psychotherapy techniques, delivered in-person and by telephone, to increase acceptance of HIV status and promoting careful and thoughtful serostatus disclosure as a specific mechanism to support retention and virologic suppression. Upon successful completion of the proposed R01 research, this study will contribute significant actionable data clarifying the impact and mediational mechanisms of ABBT on medical care retention and virologic suppression. Thus, it will lay the groundwork for the dissemination of a simple, low-cost intervention that can be integrated into usual HIV care.

项目摘要/摘要 与HIV护理联系后的头几个月，医疗诊所的辍学率高达50％， 第一次访问后，有31-46％的患者辍学。与艾滋病毒（PLWH）的人不 一贯保留在护理中 依从性，不受抑制的病毒血症和死亡率。而且，保留率差意味着有效的艺术不能是 杠杆以防止进一步的HIV传播。长期目标是通过 开发具有广泛适用性的基于行为的干预措施，可以以最低的成本执行 以及基于社区的艾滋病毒护理医疗机构的努力。该提议的目的，这是下一步 在实现长期目标并在我们成功的R34研究上建立的过程中，是进行完全动力的， 随机对照试验（RCT）评估简短的，基于2条的验收行为的功效 治疗（ABBT）干预以增强艾滋病毒护理的保留率。中心假设是参与者的 知情向其支持系统成员披露艾滋病毒状况 接受医疗的早期接受艾滋病毒状况将增加他们对护理的纵向承诺。 该提案的目的是：（1）在2臂RCT中测试ABBT干预的功效 保留护理和病毒学抑制（主要结果）；而且，艺术依从性，披露艾滋病毒状况， 相对于增强的治疗 - 通常的状况； （2）检查在HIV护理和病毒学抑制中的保留程度 通过（a）增加HIV接受（以及HIV体验避免降低）和（b）增加的介导 愿意披露艾滋病毒状况。该样本将由270名新手护理，招募的艾滋病毒患者组成 从普罗维登斯，R.I。的两个大型，地理和种族多样的艾滋病毒医疗机构和新的艾滋病毒医疗机构 奥尔良，洛杉矶。这种方法具有创新性，因为它通过使用简短的基于认可的方式偏离了现状 心理治疗技术，面对面和电话，以增加对艾滋病毒状况的接受和 促进谨慎和周到的血清披露作为支持保留和的特定机制 病毒抑制。成功完成拟议的R01研究后，本研究将有助于 大量可行的数据阐明了ABBT对医疗护理的影响和中介机制 保留和病毒学抑制。因此，它将为传播简单的低成本奠定基础 可以集成到通常的艾滋病毒护理中的干预措施。