Behavioral Depression Treatment for African American HIV-infected Substance Users

针对非洲裔美国艾滋病毒感染者的行为抑郁治疗

基本信息

批准号：
7867555
负责人：
Stacey B Daughters
金额：
$ 4.2万
依托单位：
UNIV OF MARYLAND, COLLEGE PARK
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7867555
关键词：
Abnormal coordination Abstinence Adherence African American Alcohol or Other Drugs use Behavioral CD4 Lymphocyte Count Clinical Clinical Trials Combined Modality Therapy Data Analyses Daughter District of Columbia Exhibits Feeling hopeless Goals Grant Gray unit of radiation dose HIV HIV Infections HIV Seropositivity Health Health Personnel Impaired cognition Individual Intervention Life Link Low income Manuals Mediating Medical Mental Health Minority Modeling Motivation Nondirective Therapy Outcome Outpatients Patients Pharmaceutical Preparations Poverty Precipitating Factors Protocols documentation Psychological reinforcement Public Health Randomized Randomized Controlled Clinical Trials Relapse Risk Risk Behaviors Role Staging Substance abuse problem Testing Viral Load result base cooking depressed depression depressive symptoms efficacy testing follow-up high risk sexual behavior improved inner city medication compliance meetings novel physical conditioning primary outcome public health relevance transmission process treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Approximately 37-50% of HIV positive individuals suffer from depression, which is associated with substance use, poor adherence to HIV medication, an increase in HIV risk behaviors, and subsequent poor health outcomes (e.g., Asch et al., 2003; Bing et al., 2001; Dew et al., 1997; Johnson, Rabkin, Lipsitz, Williams, & Remien, 1999). Additionally, depressed HIV positive substance users are at an even greater risk for poor medication adherence than non-substance users (Cook, Grey, & Burke-Miller, 2004). Notably, evidence indicates that HIV positive patients who receive treatment for depression exhibit significant improvements in HIV medication adherence and a reduction in risk behaviors that are directly relevant to their health and well being such as risky sexual behavior (e.g., Cook et al., 2006). Despite this link, few interventions targeting depression have been developed to meet the specific needs of HIV-infected substance users. This is especially evident for low income African American HIV positive substance users who often do not receive adequate treatment for any of these conditions due to poverty, lack of access to specialized treatment, low motivation, cognitive impairments, and a lack of coordination between medical, mental health, and substance abuse treatment providers (Calsyn et al., 2004). Thus, the objective of the present proposal is to test a novel, behavioral approach to treat depressive symptoms and improve HIV medication adherence and subsequent physical health outcomes among 170 African American HIV infected substance users residing in inner-city Washington, DC. This treatment combines (1) LET'S ACT, a behavioral activation based treatment for depressed substance users (Daughters, Braun, Sargeant, Hopko, Blanco, & Lejuez, in press), with (2) Life Steps, an HIV medication adherence intervention (Safren, Otto, & Worth, 1999). The purpose of this combined treatment (i.e., ACT HEALTHY; see Appendix for the preliminary therapist and patient manuals), will be to compliment standard residential and follow-up outpatient substance use treatment to specifically treat depressive symptoms with the additional goal of improving HIV medication adherence, substance use, and physical health outcomes. One hundred and seventy HIV positive minority substance users with elevated depressive symptoms will be randomly assigned to either treatment as usual (TAU) plus ACT HEALTHY or TAU plus Nondirective Therapy to test the efficacy of ACT HEALTHY. Treatment as usual for both groups consists of standard residential and outpatient substance abuse treatment. Based on the outcome of this preliminary trial, the ACT HEALTHY protocol will be further refined and readied for larger-scale clinical trials. PUBLIC HEALTH RELEVANCE The objective of the present proposal is to test a novel, behavioral approach to treat depressive symptoms and improve HIV medication adherence and subsequent physical health outcomes among African American HIV infected substance users residing in inner-city Washington, DC. This treatment will serve as a compliment to standard residential and follow-up outpatient substance use treatment, with the goal of reducing depressive symptoms and improving HIV medication adherence, physical health, and substance use outcomes. From a longer term perspective, this grant will set the stage for more large-scale testing to determine its utility as a specialized, efficacious treatment for a significant subpopulation at greatest risk for difficulties with depressive symptoms, HIV medication adherence, and relapse to substance use, and will therefore have important clinical and public health significance in reducing HIV transmission.

描述（由申请人提供）：大约 37-50% 的 HIV 阳性个体患有抑郁症，这与物质使用、对 HIV 药物依从性差、HIV 危险行为增加以及随后的不良健康结果有关（例如，Asch 等人）等人，2003；Dew 等人，1997； 1999）。此外，与非物质使用者相比，抑郁的艾滋病毒阳性物质使用者服药依从性差的风险更大（Cook、Grey 和 Burke-Miller，2004 年）。值得注意的是，有证据表明，接受抑郁症治疗的艾滋病毒阳性患者在艾滋病毒药物依从性方面表现出显着改善，并减少了与其健康和福祉直接相关的危险行为，例如危险性行为（例如，Cook 等人，2006 年））。尽管存在这种联系，但很少有针对抑郁症的干预措施能够满足艾滋病毒感染者的特定需求。对于低收入非裔美国人艾滋病毒呈阳性物质使用者来说，这一点尤其明显，他们往往由于贫困、缺乏获得专门治疗的机会、动力不足、认知障碍以及医疗、医疗机构之间缺乏协调而得不到适当的治疗。心理健康和药物滥用治疗提供者（Calsyn 等人，2004 年）。因此，本提案的目的是测试一种新颖的行为方法，以治疗抑郁症状并改善居住在华盛顿特区内城区的 170 名非洲裔美国 HIV 感染物质使用者的 HIV 药物依从性和随后的身体健康结果。该治疗结合了 (1) LET'S ACT，一种针对抑郁药物使用者的基于行为激活的治疗（Daughters、Braun、Sargeant、Hopko、Blanco 和 Lejuez，正在出版中）和 (2) Life Steps，一种 HIV 药物依从性干预措施（Safren），奥托和沃斯，1999）。这种联合治疗（即“行动健康”；参见附录了解初步治疗师和患者手册）的目的是补充标准住院和后续门诊药物使用治疗，以专门治疗抑郁症状，并实现改善艾滋病毒药物治疗的额外目标依从性、物质使用和身体健康结果。一百七十名抑郁症状加重的 HIV 阳性少数物质使用者将被随机分配接受照常治疗 (TAU) 加 ACT HEALTHY 或 TAU 加非指导性治疗，以测试 ACT HEALTHY 的疗效。两组的治疗照常包括标准住院治疗和门诊药物滥用治疗。根据初步试验的结果，ACT HEALTHY 方案将进一步完善，为更大规模的临床试验做好准备。公共卫生相关性本提案的目的是测试一种新颖的行为方法，以治疗抑郁症状并改善居住在华盛顿特区内城区的非裔美国艾滋病毒感染物质使用者的艾滋病毒药物依从性和随后的身体健康结果。这种治疗将作为标准住院和后续门诊药物滥用治疗的补充，其目标是减少抑郁症状并改善艾滋病药物治疗依从性、身体健康和药物滥用结果。从长远来看，这笔赠款将为更大规模的测试奠定基础，以确定其作为一种专门、有效的治疗方法的实用性，用于治疗抑郁症状、艾滋病毒药物依从性和药物滥用复发风险最大的重要亚人群，因此对于减少艾滋病毒传播具有重要的临床和公共卫生意义。