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: 10219136
• 负责人: Lilian Nazar Dindo
• 金额: $ 29.32万
• 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/10219136
• 关键词: Address; Affect; 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; RNA; 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; acceptability and feasibility; antiretroviral therapy; barrier to care; base; care providers; comorbidity; coping; distrust; efficacious intervention; 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; substance use treatment; transmission process; treatment as usual; treatment program; trend

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： HIV初级保健的保留率差会导致HIV病毒抑制率较低，HIV率较高 传播，并加剧健康成果中的种族和种族差异，包括生存。迄今为止， 当发现艾滋病毒以外发现时，没有干预措施有效地重新链接和保留PWH 诊所。许多艾滋病毒感染（PWH）的人因威胁生命但可预防的住院 经治疗的HIV感染不足的并发症。他们是保留在 关心。我们以前的研究表明，在PWH失去医疗和住院的PWH中，避免 应对，污名和心理健康困难几乎是普遍的。此外，避免应对是 预测出院后无法重新接触护理的指标。接受和承诺疗法（ACT）是 经诊断的干预措施具有解决一系列社会心理和行为相关的能力 PWH经历的问题。 ACT可以帮助患者克服回避，尤其是避免 通过促进基于接受的情况，不舒服的内部状态和触发此类状态的情况 应对和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，可接受且至少是初步的，具有功效。我们建议开发，完善和驾驶A 简短（4-5个接触时间）ACT干预，用于住院的PARE PWH。 `针对艾滋病毒保留和 通过参与改善病毒负荷'（“繁荣”）将旨在帮助患者克服避免， 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HIV相关的自我污名，所有这些构成了护理的障碍。在 出院后通过电话加强课程的医院将增加治疗的启动和完成， 缺乏通常是有效提供PWH心理健康服务的最大障碍。在AIM 1中， 一个简短的基于医院的经诊断，单独交付的ACT干预（繁荣），专门量身定制 将开发出医院外住院的PWH。来自多学科专家护理团队的输入 提供者和PHW将用于创建治疗师方案和患者工作簿。然后我们将飞行员 在10家住院的PARE PWH中蓬勃发展，他们将就干预措施提供定性的反馈。这 反馈以及患者和多学科团队的投入将用于完善繁荣。在 AIM 2，我们将对精制繁殖干预措施进行试验随机临床试验（RCT）（n = 35） 与往常的治疗相比（n = 35）。该试点RCT将1）评估全面的可行性和可接受性 比例RCT; 2）检查确定RCT感兴趣的结果的趋势。然后我们将被定位 提交单独的赠款，以测试全功率的随机试验中蓬勃发展的功效。这项工作有 减少艾滋病毒发病率和种族/种族差异的潜力，并有助于终止艾滋病毒 美国流行病，这是NIH的优先事项。