Targeting HIV Retention and Improved Viral load through Engagement ('THRIVE')

通过参与（“THRIVE”）瞄准艾滋病毒保留和改善病毒载量

• 批准号: 10082597
• 负责人: Lilian Nazar Dindo
• 金额: $ 22.01万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10082597
• 关键词: Address; Affect; Alcohol or Other Drugs use; Anxiety; Behavior; Behavior Therapy; Caring; Chronic; Chronic Disease; Clinic; Clinical; Data; Diagnosis; Effectiveness; Epidemic; Failure; Feedback; Goals; Grant; HIV; HIV Infections; Health; Hospitalization; Hospitals; Hour; Individual; Intervention; Jail; Life; Mental Depression; Mental Health; Mental Health Services; Methods; Morbidity - disease rate; Outcome; Outpatients; Patients; Persons; Population; Positioning Attribute; Primary Health Care; Prisons; Process; Protocols documentation; Randomized Clinical Trials; Randomized Controlled Trials; Research; Self Efficacy; Sexually Transmitted Diseases; Substance abuse problem; Target Populations; Telephone; Testing; Therapeutic; Therapeutic Intervention; United States; United States National Institutes of Health; Value of Life; Viral; Viral Load result; Viremia; Work; antiretroviral therapy; barrier to care; base; care providers; comorbidity; coping; efficacy testing; experience; financial incentive; follow-up; health disparity; improved; improved outcome; innovation; interest; medical specialties; mortality; multidisciplinary; outreach; peer; prevent; psychosocial; racial and ethnic disparities; randomized trial; social stigma; successful intervention; transmission process; treatment as usual; treatment program; trend; viral RNA

Summary/ abstract: Poor retention in HIV primary care results in lower rates of HIV viral suppression, higher rates of HIV transmission, and exacerbates racial and ethnic disparities in health outcomes, including survival. To date, there are no interventions that effectively relink and retain PWH in care when they are found outside the HIV clinic. Many persons with HIV infection (PWH) are hospitalized with life-threatening but preventable complications of inadequately treated HIV infection. They are among the most important patients to retain in care. Our previous research shows that among PWH who are out of care and hospitalized, avoidance coping, stigma, and mental health difficulties were nearly universal. Further, avoidance coping was a predictor of failure to re-engage in care after discharge. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention with the capacity to address a range of psychosocial and behavior-related issues that PWH experience. ACT helps patients overcome avoidance, particularly avoidance of uncomfortable internal states and the situations that trigger such states, by promoting acceptance-based coping and re-engagement in meaningful and valued-life activities. Brief ACT interventions appear to be feasible, acceptable, and at least preliminarily, have efficacy. We propose to develop, refine, and pilot a brief (4-5 contact hours) ACT intervention for hospitalized, out-of-care PWH. `Targeting HIV Retention and Improved Viral load through Engagement' (`THRIVE') will aim to help patients overcome avoidance, a maladaptive coping strategy implicated in a range of problems, including depression, anxiety, substance abuse, and HIV-related self-stigma, all of which constitute barriers to care. Delivering THRIVE in the hospital with a phone booster session after discharge will increase therapy initiation and completion, the lack of which is often the greatest obstacle to effective delivery of mental health services for PWH. In Aim 1, a brief hospital-based transdiagnostic, individually delivered ACT intervention (THRIVE) tailored specifically for out-of-care hospitalized PWH will be developed. Input from a multi-disciplinary team of expert care providers and PHW will be utilized to create the therapist protocol and patient workbook. We will then pilot THRIVE in 10 hospitalized out-of-care PWH who will provide qualitative feedback on the intervention. The feedback, along with input from patients and the multi-disciplinary team, will be used to refine THRIVE. In Aim 2, we will conduct a pilot randomized clinical trial (RCT) of the refined THRIVE intervention (N=35) compared to treatment as usual (N=35). This pilot RCT will 1) evaluate feasibility and acceptability for a full- scale RCT; and 2) examine trends in outcomes of interest for the definitive RCT. We will then be positioned to submit a separate grant to test the efficacy of THRIVE in a fully powered randomized trial. This work has the potential to decrease HIV morbidity and racial/ethnic disparities and contribute to ending the HIV epidemic in the United States, which are NIH priorities.

摘要/摘要： 艾滋病毒初级保健保留率低导致艾滋病毒病毒抑制率较低，艾滋病毒感染率较高 传播，并加剧健康结果（包括生存）方面的种族和民族差异。迄今为止， 当发现感染者处于艾滋病毒之外时，没有任何干预措施可以有效地重新联系和保留他们的护理 诊所。许多艾滋病毒感染者 (PWH) 因危及生命但可预防而住院治疗 艾滋病毒感染治疗不当引起的并发症。他们是需要保留的最重要的患者之一 关心。我们之前的研究表明，在失去护理和住院治疗的感染者中，回避行为 应对、耻辱和心理健康困难几乎是普遍存在的。此外，回避应对是一种 出院后无法重新接受护理的预测因素。接受与承诺疗法（ACT）是一种 跨诊断干预能够解决一系列心理社会和行为相关的问题 PWH 遇到的问题。 ACT 帮助患者克服回避，特别是回避 不舒服的内部状态以及引发这些状态的情况，通过促进基于接受的 应对并重新参与有意义和有价值的生活活动。简短的 ACT 干预似乎是 可行、可接受，并且至少初步有效。我们建议开发、完善和试点 对住院、非护理的 PWH 进行简短的（4-5 个接触小时）ACT 干预。 “针对艾滋病毒保留和 “通过参与改善病毒载量”（“THRIVE”）旨在帮助患者克服回避，这是一种 适应不良的应对策略涉及一系列问题，包括抑郁、焦虑、物质 虐待和与艾滋病毒相关的自我耻辱，所有这些都构成了护理的障碍。实现蓬勃发展 医院在出院后提供电话强化课程将增加治疗的开始和完成， 缺乏这种能力往往是向感染者有效提供精神卫生服务的最大障碍。在目标 1 中， 专门定制的基于医院的简短跨诊断、单独实施的 ACT 干预 (THRIVE) 将制定针对非护理住院 PWH 的计划。来自多学科专家护理团队的意见 提供者和 PHW 将用于创建治疗方案和患者工作簿。然后我们将进行试点 在 10 名住院的非护理 PWH 中蓬勃发展，他们将提供有关干预措施的定性反馈。这 反馈以及患者和多学科团队的意见将用于完善 THRIVE。在 目标 2，我们将对完善的 THRIVE 干预措施进行试点随机临床试验 (RCT) (N=35) 与常规治疗相比 (N=35)。该试点随机对照试验将 1) 评估全面的可行性和可接受性 规模随机对照试验； 2) 检查最终 RCT 感兴趣结果的趋势。然后我们将被定位 提交一项单独的资助，以在完全有效的随机试验中测试 THRIVE 的功效。这部作品有 降低艾滋病毒发病率和种族/民族差异并有助于终结艾滋病毒的潜力 美国的流行病，这是 NIH 的优先事项。