Using Principles of an Adaptation Framework to Adapt a Transdiagnostic Psychotherapy for People With HIV to Improve Mental Health and HIV Treatment Engagement: Focus Groups and Formative Research Study.
Using Principles of an Adaptation Framework to Adapt a Transdiagnostic Psychotherapy for People With HIV to Improve Mental Health and HIV Treatment Engagement: Focus Groups and Formative Research Study.
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DOI：
10.2196/45106
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发表时间：
2023-05-30
影响因子：
2.2
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中科院分区：
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参与艾滋病毒治疗对艾滋病毒感染者至关重要;然而，行为健康合并症和艾滋病毒相关的耻辱是参与的主要障碍。需要解决这些障碍并可在艾滋病毒护理环境中容易实施的治疗。我们介绍了适应transdiagnosis认知行为心理治疗的过程，共同要素治疗方法（CETA），在美国南部的艾滋病毒诊所接受艾滋病毒治疗的艾滋病毒感染者。行为健康指标包括创伤后应激、抑郁、焦虑、物质使用和安全问题（如自杀）。适应还包括解决艾滋病毒相关污名的方法和基于生命步骤的组成部分，这是一种简短的认知行为干预措施，以支持患者接受艾滋病毒治疗。我们采用了评估、决策、管理、生产、专题专家、整合、培训、检测模式的原则，这是一个调整基于证据的艾滋病毒干预措施的框架，并描述了我们的调整过程，其中包括根据专家意见调整CETA手册;进行3个焦点小组，一个由诊所社会工作者（n=3）组成，另两个由男性（n=3）和女性（n=4）患者组成，以获得利益相关者对适应性治疗的意见;根据这一投入修订手册;对2名顾问进行关于经修改的方案的培训，包括在因特网上举办讲习班，随后对3名门诊病人实施治疗，并为他们提供基于个案的咨询。对于焦点小组，所有诊所社会工作者都被邀请参加，如果患者是在诊所接受服务并愿意提供书面知情同意书的成年人，则由诊所社会工作者转介。社会工作者焦点小组的问题引起了适应治疗手册和内容的反应。患者焦点小组问题引出了行为健康状况和艾滋病毒相关的耻辱及其对艾滋病毒治疗参与的影响的经验。由3名团队成员审查成绩单，根据与调整CETA用于HIV感染者相关的主题对参与者的评论进行分类。共同作者独立确定主题，并开会讨论并达成共识。我们成功地使用了评估、决策、管理、生产、专题专家、整合、培训、测试框架的原则，使CETA适用于艾滋病毒感染者。与社会工作者的焦点小组表示，适应性治疗具有概念意义，并解决了常见的行为健康问题以及艾滋病毒治疗参与的实际和认知行为障碍。从社会工作者和患者焦点小组获得的艾滋病毒感染者的CETA的关键考虑因素与耻辱感，社会经济压力和诊所人群经历的不稳定以及一些患者的物质使用有关，这可能会阻碍参与护理所需的稳定性。由此产生的简短，手动治疗旨在帮助患者建立促进艾滋病毒治疗参与的技能，并减少已知阻碍艾滋病毒治疗参与的常见行为健康状况的症状。
HIV treatment engagement is critical for people with HIV; however, behavioral health comorbidities and HIV-related stigma are key barriers to engagement. Treatments that address these barriers and can be readily implemented in HIV care settings are needed. We presented the process for adapting transdiagnostic cognitive behavioral psychotherapy, the Common Elements Treatment Approach (CETA), for people with HIV receiving HIV treatment at a Southern US HIV clinic. Behavioral health targets included posttraumatic stress, depression, anxiety, substance use, and safety concerns (eg, suicidality). The adaptation also included ways to address HIV-related stigma and a component based on Life-Steps, a brief cognitive behavioral intervention to support patient HIV treatment engagement. We applied principles of the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, Testing model, a framework for adapting evidence-based HIV interventions, and described our adaptation process, which included adapting the CETA manual based on expert input; conducting 3 focus groups, one with clinic social workers (n=3) and 2 with male (n=3) and female (n=4) patients to obtain stakeholder input for the adapted therapy; revising the manual according to this input; and training 2 counselors on the adapted protocol, including a workshop held over the internet followed by implementing the therapy with 3 clinic patients and receiving case-based consultation for them. For the focus groups, all clinic social workers were invited to participate, and patients were referred by clinic social workers if they were adults receiving services at the clinic and willing to provide written informed consent. Social worker focus group questions elicited reactions to the adapted therapy manual and content. Patient focus group questions elicited experiences with behavioral health conditions and HIV-related stigma and their impacts on HIV treatment engagement. Transcripts were reviewed by 3 team members to catalog participant commentary according to themes relevant to adapting CETA for people with HIV. Coauthors independently identified themes and met to discuss and reach a consensus on them. We successfully used principles of the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, Testing framework to adapt CETA for people with HIV. The focus group with social workers indicated that the adapted therapy made conceptual sense and addressed common behavioral health concerns and practical and cognitive behavioral barriers to HIV treatment engagement. Key considerations for CETA for people with HIV obtained from social worker and patient focus groups were related to stigma, socioeconomic stress, and instability experienced by the clinic population and some patients’ substance use, which can thwart the stability needed to engage in care. The resulting brief, manualized therapy is designed to help patients build skills that promote HIV treatment engagement and reduce symptoms of common behavioral health conditions that are known to thwart HIV treatment engagement.