Implementing Evidence-Based Treatment for Common Mental Disorders in HIV Clinics in Ukraine

在乌克兰艾滋病毒诊所对常见精神疾病实施循证治疗

• 批准号: 10762576
• 负责人: Kimberly Michelle Hook
• 金额: $ 19.06万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762576
• 关键词: Address; Adherence; Adult; Adverse effects; Aftercare; Anxiety; Area; Behavioral; Caring; Clinic; Cognitive Therapy; Collaborations; Communities; Conflict (Psychology); Continuity of Patient Care; Country; Data; Data Analyses; Diagnostic; Eastern Europe; Elements; Epidemic; European; Evidence based intervention; Evidence based treatment; Genetic Complementation Test; Goals; HIV; HIV Infections; HIV/AIDS; Health Personnel; Impairment; Incidence; Income; Intervention; Interview; Knowledge; Learning; Life; Link; Mediating; Mediation; Mediator; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Nurses; Outcome; Pathway interactions; Persons; Physicians; Population; Protocols documentation; Psychologist; Public Health; Publications; Randomized; Reporting; Research; Research Priority; Resources; Sampling; Site; Testing; Training; Treatment outcome; Ukraine; United States National Institutes of Health; Viral; War; antiretroviral therapy; attentional control; biological sex; clinically relevant; common symptom; common treatment; comorbidity; contextual factors; depressive symptoms; design; efficacy study; evidence base; experience; follow-up; improved; innovation; interest; negative affect; post-traumatic stress; primary outcome; psychologic; randomized, clinical trials; reduce symptoms; satisfaction; secondary outcome; sex assigned at birth; therapy adherence

PROJECT SUMMARY From 2010-2020, Eastern Europe reported a 72% increase in new adult HIV infections, representing the highest rate of increase globally. Among the Eastern European countries, the HIV epidemic in Ukraine is one of the largest, with nearly 260,000 people with HIV (PWH). Nevertheless, in 2020, only 54% of Ukrainian PWH were on antiretroviral therapy (ART), and only 51% were virally suppressed. These suboptimal HIV care continuum outcomes are partially attributable to mental disorders, which are more prevalent among PWH generally (and in Ukraine specifically) and have been linked to decreased ART adherence and poor engagement in HIV care. To minimize the adverse effects of impaired mental health on HIV outcomes, creating a pathway to increase access to evidence-based mental health care is a critical public health need. The long- term goal of this applicant is to develop expertise in testing transdiagnostic mental health interventions to improve HIV outcomes among PWH in Ukraine. The objective of this K23 application is to adapt the Common Elements Treatment Approach (CETA), by incorporating the single-session Life Steps ART adherence intervention, to reduce symptoms of depression, anxiety, and posttraumatic stress among PWH in Ukraine. The central hypothesis to be tested is that the adapted CETA plus Life-Steps intervention will improve both HIV and mental health outcomes among PWH in Ukraine. The strong preliminary data supporting this application shows that community psychologists in Ukraine feel they do not have adequate knowledge to deliver mental health treatment but nonetheless have strong interest in learning short-term treatments such as CETA. To test the central hypothesis, the following specific aims are proposed: (1) To define relevant clinical and contextual factors for adapting CETA for delivery in HIV clinics and for integrating Life-Steps into the existing protocol; (2) To determine the feasibility, acceptability, and preliminary efficacy of the adapted CETA plus Life-Steps intervention; and (3) To estimate potential mediators and moderators of the adapted CETA plus Life-Steps intervention. The expected outcome of this K23 is that this applicant will gain the expertise needed in the three critical training areas of HIV and mental health, design of randomized clinical trials, and longitudinal data analysis necessary to achieve research independence. The key innovation is that this study will be the first to combine CETA with Life-Steps and evaluate its preliminary efficacy in a low- or middle-income country setting. The resulting preliminary data will also support a compelling R01 application, to be submitted in year 4 of the K23 award period, to test the adapted CETA plus Life-Steps intervention in a fully-powered, multi-site efficacy study in Ukraine. If successful, the proposed research will have significant public health impact by providing an evidence-based intervention for treating mental health problems among PWH, with attendant implications for addressing the dual mental health crisis and HIV epidemic in PWH populations throughout Eastern Europe.

项目概要 2010 年至 2020 年，东欧新增成人艾滋病毒感染人数增加了 72%，相当于 全球增长率最高。在东欧国家中，乌克兰的艾滋病疫情是其中之一 其中最大的一个，有近 260,000 名艾滋病毒感染者 (PWH)。然而，到 2020 年，只有 54% 的乌克兰艾滋病患者 接受抗逆转录病毒治疗 (ART) 的患者中，只有 51% 的病毒得到抑制。这些次优的艾滋病毒护理 连续结果部分归因于精神障碍，这在感染者中更为普遍 一般而言（特别是在乌克兰），并与 ART 依从性下降和贫困有关 参与艾滋病毒护理。为了尽量减少心理健康受损对艾滋病毒结果的不利影响，创建 增加获得循证精神卫生保健机会的途径是一项重要的公共卫生需求。长- 该申请人的学期目标是发展测试跨诊断心理健康干预措施的专业知识 改善乌克兰艾滋病毒感染者的艾滋病毒治疗结果。此 K23 应用程序的目标是适应通用 Elements Treatment Approach (CETA)，通过结合单次 Life Steps ART 坚持 干预，以减少乌克兰艾滋病患者的抑郁、焦虑和创伤后应激症状。 要测试的中心假设是，经过调整的 CETA 加上 Life-Steps 干预措施将改善 HIV 乌克兰艾滋病患者的心理健康状况。支持该应用的强有力的初步数据 表明乌克兰的社区心理学家认为他们没有足够的知识来提供心理咨询 健康治疗，但仍然对学习 CETA 等短期治疗有浓厚的兴趣。测试 根据中心假设，提出以下具体目标：（1）定义相关的临床和背景 调整 CETA 以在 HIV 诊所提供服务以及将 Life-Steps 纳入现有方案的因素； (2) 确定改编后的 CETA 加 Life-Steps 的可行性、可接受性和初步功效 干涉; (3) 估计改编后的 CETA 加 Life-Steps 的潜在中介因素和调节因素 干涉。 K23 的预期结果是申请人将获得这三个方面所需的专业知识 艾滋病毒和心理健康的关键培训领域、随机临床试验的设计和纵向数据 实现研究独立性所必需的分析。关键的创新在于，这项研究将首次 将 CETA 与 Life-Steps 结合起来，并评估其在低收入或中等收入国家环境中的初步效果。 由此产生的初步数据还将支持令人信服的 R01 申请，该申请将在第 4 年提交 K23 奖励期，以测试改编后的 CETA 加上 Life-Steps 干预的全能、多部位功效 去乌克兰留学。如果成功，拟议的研究将通过提供 治疗感染者心理健康问题的循证干预措施，以及随之而来的影响 解决整个东欧艾滋病感染者群体中的双重心理健康危机和艾滋病毒流行问题。