Brief Acceptance and Commitment Therapy for HIV-Infected At-Risk Drinkers

针对感染艾滋病毒的高危饮酒者的简短接受和承诺疗法

基本信息

批准号：
9883696
负责人：
STEPHEN A MAISTO
金额：
$ 21.37万
依托单位：
SYRACUSE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-03-15 至 2023-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9883696
关键词：
AIDS prevention Address Adherence Affect Aftercare Alcohol consumption Alcohol or Other Drugs use Alcohols Anxiety Behavior Therapy Behavioral Biological Biological Markers Caring Clinic Clinical Trials Cognitive Therapy Continuity of Patient Care Data Drug usage Failure Feedback Feeling Focus Groups Frequencies Goals HIV HIV therapy Heavy Drinking Intervention Interview Length Manuals Measures Mental Depression Mental Health Mental disorders Meta-Analysis Outcome Patient Self-Report Patients Pharmaceutical Preparations Preventive Intervention Process Provider Publishing Randomized Randomized Clinical Trials Reporting Research Risk Schedule Smoker Smoking Smoking Cessation Intervention Telephone Testing Therapeutic Intervention Thinking Time Treatment Efficacy Treatment outcome United States Viral Woman active method addiction alcohol intervention antiretroviral therapy anxiety symptoms anxiety treatment behavioral health binge drinking brief alcohol intervention chronic pain comorbid depression comorbidity comparative effectiveness comparative effectiveness trial comparative efficacy condoms craving depressive symptoms drinking evidence base experience improved innovation meetings methamphetamine use mindfulness mortality risk multidisciplinary multidrug abuse novel opioid use psychological symptom reduce symptoms reduced alcohol use secondary analysis secondary outcome sexual risk behavior skills smoking cessation success successful intervention transmission process treatment adherence treatment group

项目摘要

Abstract Alcohol consumption at hazardous levels is associated with negative consequences on nearly every step of the HIV care continuum. It is a critical factor in HIV treatment that, if unaddressed, significantly contributes to onward transmission and poor treatment outcomes. Alcohol interventions for people living with HIV (PLWH) in the United States (US) have shown mixed results, and no alcohol intervention for PLHW has shown long-term reductions in heavy drinking or a significant impact on HIV-related outcomes. One hypothesized reason for this limited success is the failure of these interventions to address the multiple overlapping problems (e.g., co- morbid mental health conditions, behavioral health needs) of PLWH who are hazardous drinkers. Innovative alcohol intervention strategies that can have an impact on these multiple behavioral health needs, in a format that can be feasibly delivered in the context of HIV care, are needed. Brief Acceptance and Commitment Therapy (ACT) is a promising intervention for HIV-infected hazardous drinkers. ACT is a transdiagnostic treatment that uses mindfulness skills and values-guided behavioral action plans to impact a broad array of psychological symptoms. ACT has shown efficacy for treatment of anxiety, depression, chronic pain, and substance use, making it a promising approach for hazardous drinkers. The overall objective of this application is to adapt an existing brief ACT intervention developed for smoking cessation, and pilot test its feasibility and acceptability for PLWH who are hazardous drinkers. We hypothesize that the resulting intervention will be preliminarily associated with decreased alcohol use, improved ART adherence, decreased symptoms of depression, anxiety, and drug use, and increased acceptance—a known mechanism of change in ACT. The specific aims are as follows: Aim 1—we will adapt an existing brief ACT intervention for HIV-infected hazardous drinkers (ACT-AU). We will accomplish this aim by: Modifying a 5-session, telephone-delivered ACT intervention for smoking cessation via iterative multidisciplinary team meetings, focus group discussions with HIV clinic patients (N = 15-20), and qualitative interviews with HIV clinic providers (N = 5-10). Aim 2—we will conduct a pilot comparative effectiveness randomized clinical trial (RCT) of ACT-AU compared to a brief alcohol intervention previously shown to reduce drinking days among HIV-infected women. We will accomplish this aim by: Randomly assigning N = 74 HIV-infected hazardous drinkers (50% women) to the intervention developed in Aim 1, or a brief alcohol intervention similar in length and frequency of treatment sessions. We will assess feasibility, acceptability, and preliminary trial outcomes. Alcohol use and ART adherence will be assessed via both self-report and biomarkers at 6-weeks and 6-months post-randomization; preliminary changes in acceptance as well as symptoms of anxiety and depression, and drug use will also be examined 6- weeks and 3 and 6-months post-randomization. The proposed research will provide essential pilot data for a R01 application to conduct a full-scale RCT to determine the comparative efficacy of ACT-AU.

抽象的危险水平的饮酒几乎对每一步都会产生负面后果艾滋病毒护理连续性是艾滋病毒治疗的一个关键因素，如果不加以解决，将严重影响艾滋病毒治疗。对艾滋病毒感染者（PLWH）的进一步传播和不良治疗结果。美国 (US) 的结果好坏参半，对 PLHW 的酒精干预没有显示出长期的效果减少酗酒或对艾滋病毒相关结果产生重大影响的一个原因是。有限的成功是这些干预措施未能解决多重重叠问题（例如，共同危险饮酒者的感染者的病态心理健康状况、行为健康需求）。可以以某种形式对这些多种行为健康需求产生影响的酒精干预策略需要在艾滋病毒护理的背景下切实可行地提供这一点。治疗（ACT）对于感染艾滋病毒的危险饮酒者来说是一种很有前景的干预措施，它是一种跨诊断方法。使用正念技能和价值观引导的行为行动计划来影响广泛的治疗 ACT 已显示出治疗焦虑、抑郁、慢性疼痛和心理症状的功效。物质的使用，使其成为危险饮酒者的一种有前途的方法。该应用的总体目标。是改编现有的针对戒烟而开发的简短 ACT 干预措施，并试点测试其可行性和我们勇敢地说，由此产生的干预措施将是危险饮酒者的可接受性。初步与减少饮酒、改善 ART 依从性、减少症状有关抑郁、焦虑和吸毒以及接受度的提高——ACT 变化的已知机制。具体目标如下：目标 1——我们将调整现有的针对 HIV 感染者的简短 ACT 干预措施我们将通过以下方式实现这一目标：修改为期 5 次的电话传递 ACT。通过反复的多学科团队会议、焦点小组讨论来干预戒烟 HIV 诊所患者（N = 15-20），以及对 HIV 诊所提供者的定性访谈（N = 5-10）——我们将进行。进行 ACT-AU 与简短的比较有效性随机临床试验 (RCT) 此前已证明酒精干预可以减少艾滋病毒感染妇女的饮酒天数，我们将实现这一目标。实现这一目标的方法是：随机分配 N = 74 名感染 HIV 的危险饮酒者（50% 为女性）进行干预目标 1 中开发的，或短暂的酒精干预，其治疗时间和频率相似。将评估可行性、可接受性和初步试验结果。随机化后 6 周和 6 个月通过自我报告和生物标志物进行评估；接受程度的变化以及焦虑和抑郁症状以及药物使用情况也将受到检查 6- 拟议的研究将为随机化后几周、3 个月和 6 个月提供重要的试点数据。 R01应用进行全面的RCT以确定ACT-AU的比较疗效。